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PERMIT APPLICATION ''IIII <br /> BUILDIN ECHANICAL/ PLUMBING /SIGN / U INKLER/ 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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: // /2r, t'iV�i� Ri. )k)A/ r'�Y PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: k)oyLPt/t/1 " 'r A 1 C TENANT NAME(If Commercial): -1�s Taft&R 4/MA ,j <br /> OWNER MAILING ADDRESS: STREET �/ 3 J.-3.n 4.Z� ,-V. �tJ <br /> CITY U t (L1 - STATE ��- ZIP M27 <br /> OWNER PHONE: !V r\ OWNER EMAIL: V <br /> CONTRACTOR NAME: ffyi-NK <br /> F/Ak-/- o-rgeffo,v (, <br /> CONTRACTOR ADDRESS: STREET /,..6"-4Q‘'' 4 ..„3/45, m '9 <br /> CITY j<"'-A/ STATE 4 ZIP 9‹�I�Z <br /> CONTRACTOR PHONE: (9-.044) t-2...,/i- CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ /s6 gl-0 <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. .❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: F aV Mfr' D� /V /*DPr /��� 9l���� p2,*K� <br /> 1��/Y� 7 VT <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/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 /> 11 City Everettoff' Official Use Only <br /> I ac?- 3 /— /� PERMIT#, / (.�oQr0®� <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />