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PERMIT APPLICATIO1ry <br /> , /, BBUILDINd4IECHANICAL/PLUMBING /SIGN r5PkINKLER/DEMOLITION <br /> 1 <br /> �r' CITY OF EVERETT PERMIT SERVICES i <br /> 3200 CEDAR STREET, EVERETT,WA 98201 g `� O <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: :>3 1 i" <br /> 1 `f `ie`- jy 5 'PROPERTY TAX#: j 'Q S'3.46� 44/o� <br /> LEGAL for new construction: Short Plat/subdivision "fii 4/L( Ii s e-i Z i Lot No. 1 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: e uCCtf7c- ,,c,/7it/c )0X7M5TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: ‘2EET,5 �v�J .mac-! /77,4_,Z,� �} 4"j" <br /> h : STATE �f <br /> ZIP L!J e <br /> OWNER PHONE: 14-Zj 2_FD— 5---217-7 (OWNER EMAIL: <br /> Citr.�/�lGi�-a 1116 At Sic/. �'n'1 <br /> CONTRACTOR NAME: C�/)� 773----5L/ed�I4 BLS / _ ? G_ <br /> • <br /> CONTRACTOR ADDRESS: s�EET 'd(yy' 2-7 <br /> t. 4erri � c•-- STATE <br /> CONTRACTOR PHONE: s(Pfj.� 1979,77 �•7/n^1 <br /> ZIP 910 1.-Z-3 <br /> (CONTRACTOR EMAIL: PZ ige_476 AD /7/-1S i /1/- , <br /> CONTRACTOR LICENSE#(REQUIRED): W /// G CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> — �/9��t�P 6-?072 <br /> PRIMARY CONTACT:5WNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:/� CONTACT PHONE: Z --- 7.-33- ,�Q3 1, <br /> D ( CONTACT EMAIL: v// <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: <br /> Contract Price of Work:$ <br /> Proposed Use of Building: `S'' r v.., Heat Source: �as ❑Electric ❑Other <br /> Building Type: DLSFR-Detached DSFR-Attached DDuplex ❑Multi-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: ew DAddition DRemodel -DRepair DT.I. OSign DSprinkler DDemolition DChange of Use <br /> DESCRIPTIO F WORK: <br /> -//-4:4 / iicie../-1;"'e."-- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT,APPLICATION <br /> PLUMBING PERMIT APPLICATION. <br /> Type of Project: New Addn Alteration Repair p Type of Project: New _Addn Alteration _Repair <br /> Fixtur#ofes List of Fixtures #of List of Fixtures #of #of <br /> Fixtures List of Fixtures List of Fixtures <br /> Fixtures <br /> A/Crc-Air Handling Units Heat PumpFixtures <br /> / Foed Air Systems Toilet Backflow Preventer(Inside Bldg) <br /> *� Unit Heater 7, Bathtub <br /> �S Gas Piping BoilerUrinal <br /> Water Heater Lavatory(Wash Basin) Drinking Fountain <br /> Refrigeration Shower <br /> Gas Fireplace Wood Stove Floor Drain <br /> t Gas Range (Kitchen Sink&Disposal Grease Trap <br /> Ducting \ Dishwasher <br /> I Clothes Dryer Hookups Other: RoofDrains <br /> Range Hood Clothes Washer Medical Gas <br /> 5--Exhaust Fan. \ Water Heater Other: <br /> Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> (Chemical or Water INo.of Heads <br /> 3KNOWLEDGEMENT:1 have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br /> rrent 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 /> ilding Official before being authorized under any circumstance.t am the owner,or lam authorized by the owner of this property to perform thework for which application is made, <br /> d I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> '-- ;: :- CD /:: City of Everett Official Use Only <br /> //2__ PERMIT#�Iner/Authorized Agent SignatureI 9 { r O I6:j <br /> Date (Revised 9/23/2016) <br />