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PERMIT APPLICATIOMII <br /> BUILDIIIVIECHANICAL/ PLUMBING /SIGN I UI RINKLER/ 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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: I ff 5 Tai 7 PROPERTY TAX# ®2&O <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: A P fv0�01 N CP ,[ A.C. TENANT NAME(If Commercial): k'1 4 � I x (LJ�� <br /> OWNER MAILING ADDRESS: STREET p, 0, g 0 yi, /8 9,5 Va,itki <br /> LI/ CINpo(RkE Silo Al6 STATE , "' LnA,•l ZIP <br /> OWNER PHONE: 1j 3 ".• .6O'f3 s a i/6,6-- TOWNER EMAIL: P/� /' •••!!!VE1,&� & ',mg ,do,n <br /> CONTRACTOR NAME: A-it? I ,he <br /> f W <br /> b il��S A✓'C <br /> CONTRACTOR ADDRESS: STREET 1), 0,s/BO x l ' -�� <br /> CITY �` t J7 Ve s W/9 STATE ZIP fe, -.0 <br /> CONTRACTOR PHONE: I$ — 5^ CONTRACTOR EMAIL: fivEk 7 A tk. 6 iti I t > <br /> ICI CONTRACTOR LICENSE#(REQUIRED): 0 Li) g i a ( CITY OF EVERETT BUSINESS LICENSE#(REQUI D):S <br /> PRIMARY CONTACT: 0 OWNER )kONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Ai/9.0 - 04P - 6 6' <br /> ''?A .a.k CONTACT EMAIL: Ae,E e l CD AtkrC.:ChM <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: AC,A/7' 40T Contract Price <br /> Aas <br /> ofWork:$ 7--COT� <br /> Proposed Use of Building: E1do .'�'•1Z Heat Source: ❑Electric ❑Other <br /> Building Type: FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family#of Units: ❑Commercial El Industrial <br /> Type of Project: ew ❑Addition ❑Remodel ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use • _ <br /> DESCRIPTION OF WORK: <br /> NNEW 6i,uG r4,44,L - ' i---- 61 DEN de- <br /> ASSOCIATED <br /> e.ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING�,/ PERMIT APPLICATION <br /> X <br /> Type of Project: New_ Addn Alteration _Repair Type of Project: JC New _Addn Alteration _Repair <br /> #of #of List of Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> 3A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> is Forced Air Systems Unit Heater Bathtub Urinal <br /> 5 Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> t Water Heater Refrigeration II Shower Floor Drain <br /> Gas Fireplace Wood Stove II 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 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 0 • ial bef•re 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 compl with -Stators Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official <br /> Use Only <br /> ,� CY11.P 8 <br /> PERM`' iI " 1 tt(vct - o03 <br /> Owner/Autho 'zed Agent Signature Date (Revised <br /> 9 9 9/23/2016) <br /> 1 ti <br />