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PERMIT APPLICATIOC <br /> BUILDING I MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> ,� CITY OF EVERETT PERMIT SERVICES <br /> '�'' 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 IFAX 425-257-8857 I E everette s everettwa. ov <br /> l www.everettwa.gov/permits <br /> (Blue_`or,Black Ink Only Please) PROJECT SITE,INFORMATION <br /> PROJECT SITE ADDRESS: 3105 p j (1 e PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: hollander InyeSamen-) TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1/9 /1. coAeon erc cl S-f. 4rles <br /> i <br /> n tt C d m CITY STATE k%4. ZIP vz <br /> OWNER PHONE: S60 '-O'Z MSS OWNER EMAIL: SQrr7e ancterSrtves+rnon4s„c=ont. <br /> CONTRACTOR NAME: Ib(fofld.er (pv ' <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: )4]OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: 5el3-t. NA4e4c:n CONTACT PHONE: 6 0 9-02 12 5 S <br /> CONTACT EMAIL: 5 Tolland irt(/e,s+men+S, Coln. <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: )-4 d 1 Contract Price of Work:$ <br /> Proposed Use of Building: Koie1 Heat Source: ❑Gas ❑Electric ❑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: Re n0v.a r;'Un DI" 1io iie(r-- 3 A 2254 6c'est foot's k-iar or tvor K oM1l�, <br /> llew� Skt.otvmr LAV. fAn <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATIONPLUMBING PERMIT APPLICATION <br /> Type of Project: _New_ Addn Alteration Repair Type of Project: _New Addn _Alteration _Repair Azmodal <br /> #of List of Fixtures #of List of Fixtures #°f List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump '2 So Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler 2_go Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration 'SSD 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 /> a.co Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/'SUPPRESSION SYSTEM <br /> Number 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 /> A./ ll ( b City of Everett Official Use Only <br /> PERMIT <br /> > . <br /> Owner/Authorized Agent Signature Date (Revised 5/ /2016 <br />