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rillill <br /> PERMIT APPLICATI ` <br /> BUILDI --.IAECHANICAL / PLUMBING / SIGIYH PRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 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: 1609 5 Th,T, LI/e/i-c- l tJh cis,1 , PROPERTY TAX#: o04616'13go 00& <br /> J5 <br /> LEGAL for new construction: Short Plat/subdivision r-E4 ices, hfui, Pop ALK.( 13'1 Lot No. a� (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ice I 1- 4( 1,-:(Lich 1 L.4r TENANT NAME (If Commercial): <br /> OWNER MAILING ADDRESS: STREET 6-50 Al ik.50// 8016 <br /> CITY EV,LLe).` STATE W A- ZIP 9. -0/ <br /> OWNER PHONE: `j')_j-Llj.:1-0114- OWNER EMAIL: Kf3CUAe L-LIC-LICJi1ktkTIOA)•1ULT- <br /> CONTRACTOR NAME: (Li 1 �� <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: XiOWNER ❑CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> zL - 2 <br /> L(T CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: eiz, kAiG- 1'A4 Contract Price of Work: $ as <,r d6^' - `u'(..) <br /> Proposed Use of Building: y11Lr [-J Sf(Z. Heat Source: ❑Gas Electric DOther ) <br /> Building Type: kSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: 41New DAddition ❑Remodel ❑Repair ❑T.I. DSign . DSprinkler DDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 6U(L-C M L) 2- _.00sf SFR.. A t l lP <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: j(i New _ Addn Alteration Repair Type of Project: Y 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 3 Toilet I Backflow Preventer(Inside Bldg) <br /> I Forced Air Systems Unit Heater 1 Bathtub Urinal <br /> Gas PipingBoiler Lavatory(Wash Basin) Drinking Fountain <br /> I Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace d Wood Stove I Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> 1 Clothes Dryer Hookups I Other:vn/WO RILL i , Clothes Washer Medical Gas <br /> l Range Hood i'l,FFce- /�"/� Water Heater Other: <br /> 3 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> /' -Th <br /> City of Everett Official Use Only <br /> 7.<:) -- <br /> 3/16 --'1'\ li PEi1�1T# <br /> � <br /> kSO 5 ` a/V'l(L( <br /> f/ (V <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />