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PERMIT APPLICATION <br /> BUILDIN `' ECHANICAL I PLUMBING /SIGN 4RiNKLER I DEMOLITION <br /> "1► CITY OF EVERETT PERMIT SERVIt= <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 ) FAX 425-257-8857 I(E)everetteps@everettwa.gov) www.everetiwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: PROPERTY TAX#: <br /> coot, row sf. C atro j 2.16518COZO <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: /by-die Eijeeett TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 12OS CAt4 ,T. ,,, /arty Suit/L.zap <br /> CITY E-Ve,te STATE WR ZIP .18zo <br /> r <br /> OWNER PHONE: S'zS -ZVI-.3f Gott OWNER EMAIL: <br /> CONTRACTOR NAME: 6(j/c- <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): 8 u Artie p?'3/(0(e- CITY OF EVERETT BUSINESS LICENSE ft(REQUiRED): 038 3' <br /> PRIMARY CONTACT: $;OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 1/2cs"`-388'-0613 <br /> attletOn Withistker CONTACT EMAIL: hwhi cee ,vreinfiute.2 e.corm <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$44ternr 4 0, <br /> Proposed Use of Building: Heat Source: El Gas ❑Electric pother <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ['Multi-Family-#of Units: ❑Commercial DIlndustrial <br /> Type of Project:,lew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: xn inn 1 ��fG/t/G.SCtt.i Si+RtG are4 towCpncre i dada") <br /> A t fe.Pz► rid-64 Ln the a t>t c.l / ids ha eA. Conc rate_post-ett y and Ali ue/li endr �ee eZso'/a rt-ai' p v jed <br /> ASSOCIATED BUILDING PERMIT#(if applicable): (.42- <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 /> LAIC-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 I SUPPRESSION SYSTEM <br /> INumber 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 /> currant 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!am authorized by the owner of this property to perform the work for which application Is made, <br /> end!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> t e: r, - . z- -/(p 131 too 3- a 11 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />