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PERMI, ,A,i''i"-ICATIO <br /> UILPING/ MECHANICAL PLUMBING / AGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVER - -'IT 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 clack link Only Please) i'CJECT SITE INFORM-TION <br /> / <br /> n 11 <br /> PROJECT SITE ADDRESS: Q 1' t/(2. S4- C 24 e4t 1.,.A„ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: J-u((g(l t' .J-fly. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET i i _` . ,V. tpftatr-C;ac( S,J, <br /> cnY &0I(("0 11.,Dw. 44 - STATE 14/t9 - ZIP 1 ?7-Z 9 <br /> OWNER PHONE: (.... 6C,} 7.01 f 2 S C OWNER EMAIL: Se/r3( FT pll o/(4Q Irt.V0 I nor,tS •6-re. <br /> CONTRACTOR NAME: btivn&r. <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 0 OTHER(Please Specify) <br /> CONTACT NAME: .CONTACT PHONE: 3 6. 1 24,2 �-- 1 2. <br /> S ofj Ari/k ,�� CONTACT EMAIL: Ser)/rq f-1QL 9 dOf J-t Va- /' -' -(S.Ct7,/j„ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 11 of Q l Contract Price of Work:$ PO. DOD <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached 0 Duplex ❑Multi-Family-#of Units: @Commercial ❑Industrial <br /> Type of Project: ONew @Addition ❑Remodel ❑Repair OT.I. ❑Sign @Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: acid 4,on a .1,� I Ts i POC s r0(' l„✓o„4.6A I e 5.4_r ty,. ,/�Gfn - f'/V/hbri/3 AR- Sop <br /> reC+0,-1,p`erI (2 g e,r V i e e S-F ;on 044 &,--f '2-1 area-- <br /> ASSOCIATED <br /> rea -ASSOCIATED BUILDING PERMIT#(if applicable): 1311 i 2'D 2-2-- <br /> MECHANICAL <br /> ZMECHANICAL PERMIT APPLICATION ("1-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 L] Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater / Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) I Drinking Fountain <br /> Water Heater Refrigeration Shower 4/ Floor Drain <br /> Gas Fireplace Wood Stove 1 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 I SUPPRESSION SYSTEM <br /> Chemical or Water O 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 /> PERM #. <br /> t\tVL(A - 1- a 17 I <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />