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PER i ION <br /> BUILD! MECHANICA PLUMBING /SI c I`=RINKLER/DEMOLITION <br /> CITY c - 'M RVI <br /> • iiffien. 3200 CEDA' ERETT,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: 642 1/ c5'/it) Y7 &,e01/1--- PROPERTY TAX#:20q/9/002012 q, 2 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION _ <br /> • <br /> OWNER NAME: Pr. gq� -j '_ TENANTfNAME(If Com rcia-:— ,r,,f moi: <br /> OWNER MAILING ADDRESS: STREET Jt27O�/ jC� G�C 6/� <br /> C/ITY ����/C/ �!e(✓ STATE ZIP 1 /� <br /> OWNER PHONE: C (3ls"w-9IN, OWNER EMAIL: 0r G i s T/-4.o'_(� �! (�f`n <br /> CONTRACTOR NAME: pz/aKe.. &��y'IXegiar es '4 , --- <br /> CONTRACTOR ADDRESS: STREET `` 7C 41 J6 a` <br /> CITY /� lialC// 76 , aST,ATEE c==-,moi ZIP q z75- <br /> arm <br /> CONTRACTOR PHONE: -,/✓,j�G f- 9/2'6 CONTRACTOR EMAIL: Grlg /Y/"G LT f (�� <br /> d ,07 <br /> /� <br /> CONTRACTOR LICENSE#(REQUIRED): L� `Z'f. r CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: PCIDWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTANT NAME• 4/025-:-.7/5CONTACT PHONE: / <br /> / CJS' CONTACT EMAIL:72,1 /%/ , . 6 / `l a`C~ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: et 4' al-joie'% .SL - Contract Price of Work:$ <br /> Proposed Use of Building:of +i '/er�Aacce.. Heat Source: ,rGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family#of Units: ❑Commercial ,Industrial <br /> Type of Project: ❑New ❑Addition Remodel El Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:�� / e - <br /> Avila, i f , ,c _ or / 44' f7,7 1 - . P, /` 6, l ; `,f <br /> e <br /> A- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New _ Addn Adlteration\ Repair Type of Project: __New __Addn __Alteration Repair <br /> #of List of Fixtures #of List of Fixtures <br /> Fixtures List of Fixtures Fixtures List of 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 HoodWater Heater Other: <br /> Exhaust Fan I 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.lam the owner,or lam 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. City of Everett Official Use Only <br /> �, <br /> pr. <br /> C462 — Ol,�j <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />