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IIII PERMIT APPLICATIO INII' <br /> ,., ,� BUILDING ) MECHANICAL/PLUMBING /SIGN 1 �IJRIN>KLER/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: (n) Ckir l ! )440,teeti 1i& PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: c n..Y .0 e Fti e.f� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 700 re,,c/a- ,S+- <br /> crr( pv e_44._ STATE 'WA ZIP L[/C 0/ <br /> OWNER PHONE: 4/2S eZr7 8ZQ? t OWNER EMAIL: m yto Asovi �7 zv_edel. 50v <br /> CONTRACTOR NAME: 01 ale."1 BO;I ft!,,i5 sy t1 i...-1s <br /> CONTRACTOR ADDRESS: STREET fp Box I I 0 9493 I Ar/my 1ei <br /> CITY AtiM.t✓;11 e STATE o yQ ZIP F73,26,--- <br /> CONTRACTOR PHONE: „2,673 A63 8 e6 3 CONTRACTOR EMAIL: le for (i lyn akv.'leit <br /> CONTRACTOR LICENSE#(REQUIRED): pi)0obt pc(ZT92 k2._ CITY OF EVERETT BUSINESS LiCENSE#(RE RED): © 39 <br /> PRIMARY CONTACT: Oi OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: y� / CONTACT PHONE: aZS7 82.03 <br /> M,Itr 1QoLO.i'/So" <br /> CONTACT EM ' N'll'n L,'.-i' oii O`er vc✓'e 1J-ida.. nay/ <br /> BUILDING PERMIT PLICATION <br /> Existing Use of Building: at,,,, e ,vid,.•j o tc, `tea.'/ ,. Contract Price of Work:$ Fs.4 4_24. cop <br /> Proposed Use of Building: Tw,yod cs,.7 O#."c+e. liA44.e. Heat Source: ❑Gas DIC)Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New DAddition ❑Remodel RI Repair DT.I. ❑Sign El Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: OtriGLf *Wt. l'tGC+iYfN 3 Se./5.44/c. V a��. VAa���- to rav y ha.1I�5 <br /> ciui:.5 'c.e✓islrvciia—% /ea,Le,e5 ieriv46 /C.47/041,22.A7 Woe&G 1 ac c am/ '1•>t <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 #°f List of Fixtures List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Nres \qxtures Fixtures Fixt4s <br /> NC—Air Handling Units \ Heat Pump ToiletBackflow Preventer(Inside Bldg) <br /> Forced Air Systems \ Unit Heater \ Bathtub rinal <br /> Gas Piping \ Boiler a\ Lavatory(Wash Basin) D?i king Fountain <br /> 3 ater Heater 2, \Refrigeration \Shower Floo rain <br /> G Fireplace ood Stove I kitchen Sink&.Bierfesdl Greas Trap <br /> Gas nge D ting ] D hwasher Roof Dra s <br /> Clothes er Hookups Oth : Clot s Washer Medical Ga <br /> Range Hoo 3 Water eater Other: <br /> Exhaust Fan j Sink(Se ice/Bar/Mop/etc.) Other: <br /> 3 1,U) <br /> SPRINKLER/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.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 /> e �/� / iJ' PERMIT#,Pe fe,ovo 0 r <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2 16) <br /> 07)7 <br />