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PERMIT APPLICATION <br /> BUILDINeH 'MECHANICAL/PLUMBING /SIGN / SPRINKLER/DEMOLITION <br /> Imo'' 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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please), PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: /7. 24..5 /6 S PROPERTY TAX#:1$4s3vt 2/6/d <br /> LEGAL for new construction: Short Plat/subdivision/0i/0, K G246 Lot No..5 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:7K e/ f4_146 -.s. 7-4/72e..,5 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: C'Z EET�� vim- ��( /./ J <br /> �`ec z % ' STATE 41/1- ZIP 96 <br /> OWNER PHONE: 17/2-5' 1.....9-0-(1-7,7'47 ///111-� <br /> OWNER EMAIL: fh/C1/) le X51. Cly, <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: / O4IY/EET /3 Gy- 471 <br /> } STATE /r/19.- ZIP W2._3 <br /> CONTRACTOR PHONE: 3/ea- 3//- , 791CONTRACTOR EMAIL: /f 4/.//,,,,s- <br /> CONTRACTOR LICENSE#(REQUIRED): ta//// j irlic. p,‹ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):1,?f) 79 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2.S.-^ j/8- D93 <br /> 174,14. / k CONTACT EMAIL: Cil-41/ / <br /> .544 e-ev-i7 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: $ F£ Heat Source: 6Kfas 0 Electric ❑Other <br /> Building Type: WIFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ` New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ('4— ��.m.•/. /e .2._- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project:y New Addn __Alteration Repair Type of Project: New Addn Alteration Repair <br /> #of — -- — <br /> #of #of <br /> Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> #of List of Fixtures <br /> Fixtures Fixtures Fixtures <br /> NC-Air Handling Units Heat Pump .3 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 /> S Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> 'Chemical or Water I INo.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 /> _CDh__ �d ‘.77 ,2 <br /> PERMIT# <br /> ( '7 0 40' —030 6/t <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />