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PERMIT •,PPLICATIO= <br /> iderp._ ,,i_a__ <br /> BUILDING I MECHANICAL I PLUM':ING I SIGN I 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 www.everettwa.gov/permits <br /> '(Blase orr i`,Iack Ink Only PlZease) Pi liJI!CT SITE INP RM%'TR. <br /> PROJECT SITE ADDRESS: ) L(Z SISjA✓lifU4 Obi{ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Don/ (-" II TENANT NAME(If Commercial): <br /> (jl�S <br /> OWNER MAILING ADDRESS: STREET 3 ' 1? d <br /> /WV tvA `l 22,9 2 <br /> CnY SAN kit. Or) STATE t /1 ZIP <br /> OWNER PHONE: 31:b— -�h`i 443' OWNER EMAIL: ./14 r L-K co Rol....,C 0�J <br /> CONTRACTOR NAME: 1):>A/ 5 (-- <br /> CONTRACTOR ADDRESS: STREET <br /> • <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: QZ�_ '>(� >��.3CONTRACTOR EMAIL: � 4r .j(f �" p) <br /> �� •,lam, /�/ <br /> CONTRACTOR LICENSE#(REQUIRED): %IZIl g3cl R„.jl Y OF EVERETT BUSINESS LICENSE#(REQUIR ): (J -_ - <br /> t <br /> PRIMARY CONTACT: IkOWNER Lii.CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: C:21(_ 42y-, ‘_1S>3 <br /> &A/ GAAP CONTACT EMAIL: ��MM-Q tor- Wytlro P ad...<(1(21 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: (.bMD — �r-r2-- Heat Source: L,Gas DElectric DOther <br /> Building Type: ❑SFR-Detachedly❑SFR-Attached ❑Duplex DMulti-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: h lew DAddition DRemodel El Repair DT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 1t evv ,� t e ;L <br /> i. <br /> S A.FEQ-h .-o e Act_ • exipn <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 #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C–Air Handling Units Heat Pump ticv Toilet Backflow Preventer(Inside Bldg) <br /> I Forced Air Systems Unit Heater la Bathtub Urinal <br /> 3 Gas Piping Boiler 43 Lavatory(Wash Basin) Drinking Fountain <br /> ( Water Heater Refrigeration `Z_, Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> I Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: / Clothes Washer Medical Gas <br /> • Range Hood ` , Water Heater Other: <br /> Lk Exhaust Fan p Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water O No.of Heads <br /> ACKNOWLEDGEMENT:t 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 /> comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 61\1\ISIAV/ <br /> O•r •.thorized Agent Signature Date (Revised 9/23/201 ) A <br />