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PERMIT APPLICATION <br /> '1,.--a <br /> BUILDING/ MECHANICAL/PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> 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: ;Gf i4 PA1I.4 AV t - • PROPERTY TAX#: kalettlaP <br /> LEGAL for new construction: Short Plat/subdivision A-mcHuj Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:0102er 06ejlet b/57 TENANT NAME(If Commercial):�y I "Ilf��.G cJ iix,„. <br /> OWNER MAILING ADDRESS: STREET rOIOiNie)ApWA'/. 9 <br /> rr cnY Ve STATE AA • ZIP ! / <br /> OWNER PHONE:44tø 05. 194, OWNER EMAIL: <br /> CONTRACTOR NAME: giu-ii It Ci C.52. <br /> CONTRACTOR ADDRESS: STREET <br /> CITY - STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED.): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR PLOTHER(Please Specify)A <br /> CONTACT NAME: CONTACT PHONE: 206 •44 •452E <br /> /s4 .I� <br /> 4 Je. &r+ CONTACT EMAIL: h ' ` M C.' ':7 , 4 ki t *.e <br /> ��r- BUILDING''PERMITAPPLICAI; ON C000000 7 Z ' <br /> Existing Use of Building: ill/britContract Price of Work., �� ' <br /> MIII <br /> Proposed Use of Building: ONMit GM4i Heat Source: ,$ as `■ EWlil P' `*�L .. <br /> Building Type: ❑SFR-Detached ❑SFR-Attached El Duplex ❑Multi-Family-#of Units: Scommercial ❑Indus ial <br /> Type of Project: ❑New ❑Addition emodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler .:Demolition ['Change of Use <br /> DESCRIPTION OF WORK: <br /> 1•11-414, /0 e-Jf c4 tier 5 e14) 74-11, Flit tD5 af,C 4fil/t.+�i <br /> nON MztVt4 64414Cal 15 fel Mb MOP ferWiz. 0 <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 /> 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 Hood Water Heater Other: <br /> 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 1 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 /> / PER # <br /> Ii/141/7 -< < -0th <br /> O r/ ut orized Agent Signature (Revised 9/23/2016) <br /> t� <br /> U <br />