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''IIII II IIII PERMIT APPLICATIO I <br /> oi <br /> '- DUILDIN(� IECHANICAL/ PLUMBING/SIGNPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 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: ®FP- (1 1 i4L---7 b�1 PROPERTY TAX#:001.3•t0a,(2(9 OC,( C.> ( <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: • S ® — TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: (` W <br /> CITY STATE ZIP <br /> OWNER PHONE , -4/ (OWNER EMAIL: <br /> CONTRACTOR NAME: _ -•••,Cyki",29..._ p,� ,' ii Luc( <br /> CONTRACTOR ADDRESS: STREET %"4": Cg, t 'A��J- _% �,,- n Iv <br /> CM' Ct,gl j r� STATE.20(s 012..a. <br /> 1/ <br /> CONTRACTOR PHONE: .20(s0(11 1)3% CONTRACTOR EMAIL: sc.,.....Qn e `_ <br /> CONTRACTOR LICENSE#(REQUIRED):sc a eLcswi k .. ,-- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED: t. ` <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) ma , i 1 3(7 <br /> 1-4/01 <br /> CONTACT NAME: <br /> i CONTACT PHONE: CAS `-7/9 �-i l 7. 3 <br /> 1— s l�1" �' � l CONTACT EMAIL:` Ud�;�@ ✓Weft"1- 00, 't,¢�D�1 5.,,CO_M <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 'ten 7L t 1,Z-- Contract Price of Work:$____(5c)_,,Cha® `' . <br /> Proposed Use of Building: , A,Q0 ,(--• Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ['Duplex 6XMulti-Family#of Units:4 ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign El Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Writ R ,k ^o O--- lK O( u e, ' zi_pu <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <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 /> 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 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 Contr ctors Law 18.27 RCW and 296.200A WAC. <br /> /� / City of Everett Official Use Only <br /> At � <br /> ( T 90 • 1 i(� PERMIT 'l 1 ),-b <br /> j <br /> Owner/Au. orized Agent Signature Date (Revised 9/2 /2016) <br /> 1----"\\ <br /> ii\--. 1 <br />