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Phi,MIT APPUICA`I°IO• <br /> 00w <br /> UILDING I MECHANICAL/ PLUMBING I SIGN /SPRINKLER/ 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 l www.everettwa.gov/permits <br /> (Blue or 1;lack Ink Only Please) PRe JECT SITE INFO=MTION <br /> PROJECT SITE ADDRESS: 3 7 2 3 ppytAv.�, {,eot. C4- h PROPERTY TAX#: 4e to G7 9 eel 66G <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: "33 Z 3 /iy'/'4/,C. L( (-- TENANT NAME(If Commercial): <br /> P OWNER MAILING ADDRESS: STREET /t ter(( ti lli, i I• I-wit ' a a <br /> CITY L7 4 h,0&/ STATE W4. ZIP J 162 7 <br /> OWNER PHONE: 204 , Z Pf•-„?/70( OWNER EMAIL: 44/40,1 „ e.f "pf- e5,,g.(•ea i <br /> CONTRACTOR NAME: L,e4 Die-IT elJi ,G Co to.1.74'4 1-7� 71, t h/C <br /> CONTRACTOR ADDRESS: STREET 1777 f My-h411-oh P'/' , -0577 <br /> CITY Pt v /1 J5 / ” STATE 1v4 ZIP q;22 2 <br /> CONTRACTOR PHONE: q'L,f:-F 70- 0.7.1-474 CONTRACTOR EMAIL: l r4,prk 2.Q c h[ f c G yfr,4^;(•G ch, <br /> CONTRACTOR LICENSE#(REQUIRED): L VA. D .E P7 2 67 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER *CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: / CONTACT PHONE: /+ 2�/�7a-C S® <br /> Vii-4.0? -a-ecrA 4 Goy CONTACT EMAIL: 17"..-4 `2 diXli4k 4 cl.1/'7A,P( -GGlt <br /> BUILDING PERMIT APPLICATION / <br /> Existing Use of Building: —IF I? Contract Price of Work:$ 706 r p Ga <br /> Proposed Use of Building: 2. tido!«5 11.4 6- li-( 9 � Heat Source: lTGas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached Duplex [&Multi-Family-#of Units: 'Z ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition DRemodel DRepair ❑T.I. ❑Sign El Sprinkler El Demolition El Change of Use <br /> DESCRIPTION OF WORK: r , <br /> ASSOCIATED BUILDING PERMIT#(if applicable): — it «di 029 <br /> MECHANICAL PERMIT APPLICATION PLUMBING( " '\ <br /> 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 #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Cr Toilet I Backflow Preventer(Inside Bldg) <br /> "2, Forced Air Systems Unit Heater Li Bathtub Urinal <br /> Gas Piping Boiler to Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove 2 Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting -2. Dishwasher Roof Drains <br /> ''Z, Clothes Dryer Hookups Other: "2. Clothes Washer Medical Gas <br /> Z Range Hood (,"Z� Water Heater Other: <br /> 7 Exhaust Fan '2.. Sink(Service/Bar/Mop/etc.) Other: <br /> /SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> A NOWLEDGEMENT:•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 /> �j, �% / / PE nni .0 86q <br /> Owner/Authorized Agent Signature Date (Revis!d /23/2016) <br />