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PERMIT APPLICATJ14II <br /> 7 <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 3 5140 t"1 o u 3 .\\ )v PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: =tiC 1�2/J i L TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET © 13.-K Z 50 <br /> CITY J\)\RS STATE T N ZIP 37z O Z <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Uto \.i�"12S`JN Q\6L0,kl)UtJ /NC, <br /> CONTRACTOR ADDRESS: STREET y/OZ A/4/ <br /> CITY 41.410 4.4.0-4,1 STATE 1.40/4 ZIP 18001 <br /> CONTRACTOR PHONE: � 3 ' c,—jj5 Of CONTRACTOR EMAIL: C ce vi rer^Sa l i .b6M <br /> CONTRACTOR LICENSE#(REQUIRED): / 9h'f CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER I$CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: '3 3 - <br /> CONTACT EMAIL:nticay►e_S epzeni12'.r^+ eY'Pri^ y. "'AAA <br /> BUILDING PERMIT APPLICATION r <br /> Existing Use of Building: Contract Price of Work:$ Ii 0 o 0 Oct <br /> Proposed Use of Building: Heat Source: ISIGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: tICommercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> '?e9\ckce CZ) 1-xt5rtni to Gas . 01-1.Agce , 5 Ltt A-/c Sys'7t S W LT.-4 <br /> \G\N JI syST4:)--nS cArkACE 6'2)C6) <br /> ASSOCIATED BUILDING PERMIT#(if applicable): �(r�� .4A-te 4/r £Nt/Z r—.019P,e9r 2 ZB 54) <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> 2. 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&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER(SUPPRESSION SYSTEM <br /> Chemical or Water 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 /> 1 City of Everett Official Use Only <br /> 7(17- a PER � <br /> 111001 O lJl� <br /> Owner/ dtho • •e ent S's nal re Date (Revised 9/23/2016) <br /> 1 Z✓ <br />