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• <br /> PE`r"MIT APPLICATI <br /> OUP" BUILDING I MECHANICAL/ PLUM=ING/SIG SPRINKLER I 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 I www.everettwa.gov/permits <br /> `(flue or It lack Ink Only Please) P OJECT SITE INF RMATION <br /> PROJECT SITE ADDRESS: 1f 53P Cello/ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision t Lot No. (attach copy of long legal description) <br /> Cc.,NTACT INFORMATI,• <br /> OWNER NAME: Co Jan ,AfrsC4€ /� <br /> 1✓ V.` TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Z414 <br /> pike '� <br /> ... CITY �0 STATE ieti /jk ZIP %g I <br /> OWNER PHONE: OWNER EMAIL: b <br /> CONTRACTOR NAME: 11.4/"-i-lam 1491e- <br /> CONTRACTOR ADDRESS: STREET <br /> MY STATE ZIP <br /> CONTRACTOR PHONE: p CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): Kiprr-1lL9=✓ I Dtr CITY OF EVERETT BUST 8 # <br /> LICENSE/(REQUIRED):©4�7Q 1 tee53- <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR OTHER(Please Specify) Arays- pf - (�'1/0 <br /> CONTACT NAME: / CONTACT PHONE: t 1+ 10i. cs�p 0 <br /> / !Lre-'ter`^ CONTACT EMAIL: lf.'G,atrP(fele, �, /o . .... <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ \ `� `� <br /> Proposed Use of Building: • Heat Source: ❑Gas @Electric ❑Ober <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: @Commercial ❑Industrial <br /> Type of Project ❑New @Addition ❑Remodel ❑Repair ❑T.1. DSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 4 OILS 4 aft, .0e($fici, 4,14,049l`I5 410k sfrp-!it <br /> O Gu ® /ro e oarie 7'""f s e e-�- <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 #°f List of Fixtures #°f 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 /> I 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 l 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 comity with the State Contractors Law 18.27 RCW and 296.200A tiONIP <br /> City of Everett Official Use Only <br /> /V/ PERMIT#%�� (Revised <br /> OwnerlA�r,• d Agent Signature 9/23/2016) d\:\,_ <br />