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PRIT
<br /> BUILDING /MECHANICALS PLUMBING I SIGNN/SPRINKLER/ DEMOLITION
<br /> Oajerr
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) > PROJECT SITE INFORMATION{
<br /> PROJECT SITE ADDRESS: 3202 L©.16afe/ 4/2 'e(,�+,£v, 4 PROPERTY TAX#: 00`13q 0?CyOJ01
<br /> k ,
<br /> LEGAL for new construction: Short Plat/subdivision 4.4,c: 7641 Lot No.37, (attach copy of long legal description)
<br /> �''�p]� Sig 1 CONTACT INFORMATION
<br /> OWNER NAME: Vr-��lin uer. TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 3701 Y1?eitcX d,/'J'✓ -
<br /> CITY 5✓e,- r/ STATE ZIP --.Y1(20/
<br /> 0/
<br /> OWNER PHONE: 1125- ,b7 8'7/7 OWNER EMAIL: .$/COI ;ivhn 6-:-.1,, ;/v'v"' j
<br /> CONTRACTOR NAME: .3q4/e,, q j r,7 r,.(/01e,"" f
<br /> CONTRACTOR ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: ''�3 j f CONTACT PHONE: � a(O7 29/7
<br /> t✓J1( . ,,e. CONTACT EMAIL: 54.7e jp.,41 ,,,,r4p/coof
<br /> BUILDING PERMIT APPLICATION
<br /> Existing Use of Building: 14>7.P41:,4ed '6 e1j'f Contract Price of Work:$ 1C00
<br /> Proposed Use of Building: tr/i4j9, � '�yecre Heat Source: ❑Gas ❑Electric ❑Other
<br /> Building Type: ❑SFR-Detaches ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial
<br /> Type of Project: :New ❑Addition ❑Remodel ❑Repair ❑T.I. OSign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION. nOF WORK: y_g 4�f001, 1 q//,f d c✓ J4 .1 M , 6ct e,47 el
<br /> P("1/ ' ill°ek 7 b'y "reVal.f.5 oc ul�•�(;�/e/CCfftc/( geld 641h,00,41 i4 b ce ei 71-
<br /> efeclr,-cet/ i'Ic/aa/e.; l frh1" G,d a c;.-cu,/ breuke,' L,)4,1ch ida.-/ctfit iaa4jV ct,l_
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): Afeiloce, The rn«Ce 1.4)4, 14.,ye sd ,DIO'a^' 6y .i/&'fei-
<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 /> A/C-Air Handling Units Heat Pump 1 Toilet Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater Bathtub Urinal
<br /> r Gas Piping Boiler I Lavatory(Wash Basin) Drinking Fountain ,
<br /> ' er er _.... Refrigeration j Shower Floor Drain
<br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap
<br /> Gas Range Ducting Dishwasher Roof Drains
<br /> I 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 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.1 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 /> PERMIT#
<br /> 0 er/Authorized Agent Signature Date (Revised 9/23/2016)
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