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gir ERMIT APPLICATION <br /> BUILDING MECHANICA 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 I(E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: /3 O y 26t741 Sr S R PROPERTY TAX#: 47"3922 O o o o)9 o Z. <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ,.4 <br /> CONTACT INFORMATION =` <br /> OWNER NAME: ESE FdbL/c SCyo oL S TENANT NAME(If Commercial): SG'/,vcE 'owtcf &T2 Ret.o <br /> OWNER MAILING ADDRESS: STREET 3 9 00 ."E P-0 AID w"-.l <br /> CITY 6.-1/6726-77— STATE WA ZIP 9g2-0/ <br /> OWNER PHONE: 92C-385 ^4"/92 OWNER EMAIL: <br /> CONTRACTOR NAME: Pio Lwt.b ei2.49 V 1 f ja ANt C q L_ <br /> CONTRACTOR ADDRESS: STREET�6//55/ d47 O $E 3 0 7LLj ,P 0/7e /O o Q(� � <br /> CITY 6t_c.E V C E STATE IdiotZIPJ 7S o o .7 <br /> CONTRACTOR PHONE: 9/S^ 822- 22 3 3 CONTRACTOR EMAIL: PHANN A N UflLhh&fr2ro, Co rv/ <br /> CONTRACTOR LICENSE#(REQUIRED): N 0 Lyng e * 0(o t, rn E CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): OS/0 o 3 <br /> PRIMARY CONTACT: 0 OWNER gCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4/2s- Z"2 2 - 2 2 3 3 <br /> NANCY SPrN1 -oS <br /> CONTACT EMAIL: A/ANc.y5 Q h'oui.eft gCo , Co rv7 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ lop 1 144., 00 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair CIT.!. ❑Sign ['Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: •=1„1 5-r/qLA. oLECu9st-t t) - r 1 f-'vwlc pool OVG-rrA0I Z- 1 -r [<kFXreftS <br /> ANO dyer 0)04-0-1OA 4410ns a-l-►tti.S. Coo-04141INt c.44 Z+JSvu-rzn.v r —ct ?4., 4113.kit:+l: <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 /> 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&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood I IN Cr PA J Water Heater Other: <br /> Exhaust Fan 2. pv L-(f4eAzk►5 Sink(Service/Bar/Mop/etc.) Other: <br /> MERrr tiara v144.1 <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 /> City of Everett Official Use Only <br /> -i/ /, PERMI , OtyQ ! 06,0 <br /> Owner/Authorize. - Date (Revised 9/23/2016) <br />