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PERMIT APPLICATIO�,I 2 <br /> BUILDIN�) MECHANICAL I PLUMBING I SIGN !SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES 2314- W e m ec f.ye UN/7S CSD <br /> iiiiiiiijiffr 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:33q'-E kfigl. (-V I�vt", Gt-0 VD) PROPERTY TAX#: 604'56°179` 0 q0 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)! <br /> * � nn 1 t CONTACT INFORMATION <br /> tV <br /> OWNER NAME: e79--„ ( d Y ,A31.- > ' TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS:.(` 1 STREET 2/VLd (4-. S 5 <br /> cnY {e---ki2 tip STATE LAJA ZIP Ci,•6 0 SS <br /> OWNER PHONE: ZO 6 22-7 °,6 5-4 OWNER EMAIL: RAI C9-114At L o Cg11/\ <br /> CONTRACTOR NAME: Q UJ r.... -1312___ <br /> CONTRACTOR ADDRESS: STREET tarS P...- C\...1 z <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: �r7°//OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: c/� '�/� CONTACT PHONE:��w 6 "Z-7_,-7 G1( <br /> AIS �' S I CONTACT EMAIL: 6 tqc5RA �t1 co Cs-/Y -t L✓ a LO/lA <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ ,et s c2co ,o-a <br /> Proposed Use of Building: S 1 I ST(I?L U'IYti Heat Source: ❑Gas VfElectric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached 'Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: New ❑Addition DRemodel 0 Repair DTI. OSign DSprinkler ❑Demolition ❑Chhange of Use <br /> DESCRIPTION OF WORK: Ne 1.1 ( /2) Motkrri pa., umtl:S Turnt, 3(<2.-4 `V43,1, it U.I J <br /> 2 GA-eits,6-eS 175 L, ON TE+ --- VAST S1p1- OV- PP--(1) '&e2 xe <br /> Lgv tL1N k('6-2) -51-o ' /2 614) 12445-k-WM, 21S cwr -P1.1Tu.k e-t.l <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBI1 G PERMIT APPLICATION <br /> Type of Project: V New_ Addn _Alteration _Repair Type of Project: V/New Addn _Alteration _Repair <br /> #of #of List of Fixtures List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air SystemsUnit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> 2.. Water Heater Refrigeration Shower (W `F'(ItS) Floor Drain <br /> Gas Fireplace Wood Stove 2.. Kitchen Sink&Disposal Grease Trap <br /> Gas Range xDucting ' Dishwasher Roof Drains <br /> 2. Clothes Dryer Hookups Other: ,fL• 2 Clothes Washer Medical Gas <br /> 2 Range Hood IcteC. Nater Heater Other: <br /> 1,6 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 properly 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 /> k__—_-S _ 5-VGt'`7,0\ PERttl <br /> Mo —01 ' <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />