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I I 1I 1'1I PERMIT APPLICATIO II <br /> Alliglid7"4 <br /> BUILDINU 4IECHANICAL/ PLUMBING /SIGN 15'PkINKLER/ DEMOLITION <br /> NaligWiCITY 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 /> >�j <br /> PROJECT SITE ADDRESS: q 2 1 g !p " i \ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: An l.,L Mr? TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET % 'qZ1 S /8 /4-ve._ VI/, <br /> CITY k ve,re,H STATE WA ZIP CI F2-01/ <br /> OWNER PHONE: LI 2,S-- 2`d 0' 7 73c OWNER EMAIL:<411;t6tvfeAdi I y 6S©9v4,a,%,coin., <br /> CONTRACTOR NAME: A f\i- I/ 07 <br /> CONTRACTOR ADDRESS: STREET 2 0 2 0 6:13 ,' P L , <br /> CITY it PI ii W STATE V J Ll ZIP q A 036 <br /> 6 <br /> CONTRACTOR PHONE: /'2. 5— 6 2 6 17,5'7 53 CONTRACTOR EMAIL: r- 9� <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: g 2_5 6. 2 6 6/ 5 7 <br /> A I y/ t`' 1011 CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION //,, <br /> Existing Use of Building: Contract Price of Work:$ l(l),re7 <br /> Proposed Use of Building: Heat Source: OGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. DSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> I AI t'a/ (2? vl; yt 7 ©vr -Ike top ',/ deck <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 #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-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/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.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 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> l PERMI w \— oo2- <br /> Owner/Authorized <br /> /] I iI/ / (g Agent Signature Date (Revised 9/23/2016) 'lift <br />