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grr PERMIT APPLICATIO <br /> BUILDINCECHANICAL/ PLUMBING /SIGNRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 ((E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: .2$d3 <br /> /e- f71" . ,a4_ PROPERTY TAX#: 36--45117 d.:z/• <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) d kr <br /> CONTACT INFORMATION <br /> OWNER NAME: if ' ..17-51./S 2 ,(L.( tie Tgy,AAIT-NAME(If Commercial): ._,•;•77—, f- jley" <br /> OWNER MAILING ADDRESS: STREET /17:0 i 6 O 3-117( <br /> ,1O 40I.(f cITY 14/4- STATE /V , ZIP �� <br /> OWNER PHONE: tf:sr `702 V3$ / OWNER EMAIL: t� � v' <br /> e, ,ASn .0 h1 a// a (0 <br /> CONTRACTOR NAME: 4 f4/07 jJ?/" C / <br /> CONTRACTOR ADDRESS: STREET / <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACTWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2.53 5 9 7 27 <br /> 3-- 'F (0:L�i IJ CONTACT EMAIL: e1, �S,,yL e air j t ./ yy�, <br /> B LDING P RMIT APPLICATION �" <br /> Existing Use of Building: fiej-frdpite Contract Price of Work:$ P,/)Q <br /> Proposed Use of Building: /' Prf"/CC 4' Heat Source: ❑Gas lectric ❑Other <br /> Building Type: $FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel El Repair 01-.1. ❑Sign ❑Sprinkler ❑Demolition El Change of Use <br /> „-/p <br /> DESCRIPTION OF WORK: f ,d< ( ,p����� f 4/0:0:10 <br /> t� 471), ..0^,�7 Inorf! c,,,",de -..r �� sit %ie/€get.r j— <br /> ASSOCIATED BUILDING/PERMIT#(if applicable): Nti <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _AlterationRepair Type of Project: _New _Addn _Alterationepair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump / Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> 'Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> / Water Heater Refrigeration / Shower Floor Drain <br /> Gas Fireplace Wood Stove / Kitchen Sink&D osal Grease Trap <br /> _Gas Range Ducting Dishwasher Roof Drains <br /> /- Clothes Dryer Hookups Other. Clot Washer Medical Gas <br /> Range Hood er r �� Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Chemical or Water I No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> 'Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> d #/1"--- - IA0 PE AT# ofE\ ,_0 ,1._Owner/Auth• ize• ' •ent Signature (Revised 9/23/2016) ,1,a-____. <br />