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II IIII PERMIT APPLICATION II'' <br /> BUILDING+LECHANICAL/PLUMBING /SIGN/9PINKLER/ DEMOLITION <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: 61 Y7.J 2i-(- Da ctverr,Priv/(k (MD PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of tong legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 94a4k h re TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET qg Z(® 2,4yS ®12_ St... <br /> CrfY e,1- STATE j ZIP 9?ug <br /> OWNER PHONE: l 4 2r . <br /> i - os-- ('7 OWNER EMAIL: 5S e----114—€3 rc--KqqJ . C ofrvl <br /> CONTRACTOR NAME: ItkOl tf,,.6W v'1,eAr <br /> CONTRACTOR ADDRESS: STREET <br /> CRY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): VV CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):1 i <br /> PRIMARY CONTACT: ,OWNER 0 CONTRACTOR El OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATIO <br /> Existing Use of Building: Contract Price of ork:$_ <br /> Proposed Use of Building: Heat Source: s DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Ill Commercial [Industrial <br /> Type of Project: El New litKddition ❑Remodel El Repair CIT.!. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> pel)4.n i4 3 %- `-. 4 1'.,`,,,j Sidefe- -k e1i)41,-1 k- 4 <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 #of #of #of <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump I Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater 1 Bathtub Urinal <br /> Gas Piping Boiler '2— 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 /> 1 Clothes Dryer Hookups Other: i Clothes Washer Medical Gas <br /> Range Hood Water Heater Other <br /> 1,, . Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water 1 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 properly to perform the work for which application is made, <br /> an. ., eS- '.n o RCWand 296200AWAC. <br /> /�" City of Everett Official Use Only <br /> r_ % � <br /> r� /���� . &Iglu n PER T# (-4.0cc, ....d-3 2_ <br /> Ow - • t 7'7:4 • <br /> ate (Revise 9/23/2016) <br />