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PERMIT APPLICATIC:.. <br /> � �� BUILDI MECHANICAL/PLUMBING I SIGRINKLER/DEMOLITION <br /> �� CITY OF EVERE I I 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: / Z Z a /JCkEr 4v PROPERTY TAX#: 00 ocitiz zzh,0Z7 00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:&err/f E$'lf;.p�i/,¢N I E VEPA/Sre4 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: I STREET /ZZ.2 &&GLE' Ave_ <br /> / <br /> CITY L►(�ere STATE Wiet ZIP 9g20 I <br /> OWNER PHONE: 4z5 - Z SO le-/41? OWNER EMAIL: Q4 e E f) 0 Coil' c�st",N E± <br /> CONTRACTOR NAME: C �Es± Cot4s� ichoil t" <br /> CONTRACTOR ADDRESS: STREET //207 45-44' 4,,,e. /vE <br /> CITY 4eS y%l/IE STATE WA- zip q' 1 7/ <br /> CONTRACTOR PHONE: '/25 - 2-3 8-3z66 CONTRACTOR EMAIL: C j,msrconrcdc--esu 0 4 , <br /> CONTRACTOR LICENSE#(REQUIRED):C J ''TC 5 O635 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)t 4106 <br /> PRIMARY CONTACT: D OWNER 'El CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: .CONTACT PHONE: 25---03 8 -326.6 <br /> Cr4 t I� ,kf CONTACT EMAIL: C.,kA)Es°-teo:i - uCI`I(3 42p,--,2,14/6-..-4 Co <br /> rsi <br /> BUILDING PERMIT APPLICATION 1 <br /> Existing Use of Building: Q E5(GI E/44'14 I 1-40,01 C Contract Price of Work ft,- ‘41-6461-fret R$d OOCJ <br /> Proposed Use of Building: S4ts1 E 11 Heat Source: i Sas 0Electric •ether <br /> -r— Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex DMulti-Family-#of Units: a ommercial Dlndustrial <br /> Type of Project: DNew INAddition IltiRemodel DRepair OT.1. OSign OSprinkler DDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Acid Nei.) z c 21( SsG4Id1 s 4n d- 4rtiod>• ( LuEsT f4C.i ►C; 5'dE f.-e bus E 4v VIEW •DEcY. <br /> 43(.1 .,._ <br /> ,I� ; tAfet x 2S 303 sF �I <br /> ASSOCIAT #(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: X New Addn OC Alteration Repair Type of Project New Addn Y Alteration __Repair <br /> #of List of Fixtures #of <br /> List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump 1 Toilet Backflow Preventer(Inside Bldg) <br /> ( Forced Air Systems Unit Heater 1 Bathtub Urinal <br /> ( Gas Piping Boiler I Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration I Shower Floor Drain <br /> Gas Fireplace Wood Stove I Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting I Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> I Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <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 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 /> /........_____ i' <br /> /4/d------ g 3-f3 - ' PEI7j(go o3 - 00g <br /> n <br /> Owner/Authoz41 Agent Signature Date (Revised 9/23/2016) <br />