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IIIIII PERMIT APPLICAT <br /> 4 ,111111111P.. BUILIM I MEC'IANICAL I PLUMBING I SIGN I SPRINKLER/DEMOLITION <br /> +' CITY OF EVERETT PERMIT SERVICES <br /> ti� <br /> • 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425257 8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov www.everettwa.gov/permits . <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 'j 9 5.2— .5.r PROPERTY TAX#: n 0 +0 2 0 0 0 O 510/ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: IlVt1/41 cJ0-1 424.tz- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 5 ii 0`Z- o A-W frcLcp�p� <br /> ..CITY 1/c ii-&'r STATE �•,-/&-- ZIP �J C ? ,� <br /> OWNER PHONE: 'LP!v (4-9. -70 j OWNER EMAIL: .D w as & e. t A- `e' <br /> CONTRACTOR NAME: 5A--wA.:e— <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: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICAT •N ,( <br /> Existing Use of Building: Contract Price of Work:$ •Z 0©-" &N. <br /> Proposed Use of Building: Heat Source: • as DElectric ❑O r <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Unit mmercial ❑Industrial <br /> Type of Project ❑New ❑Addition ❑Remodel ❑Repair DTI. ❑Sign ❑Sprinkler LJDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Lk. <br /> ASSOCIATED BUILDING PERMIT#(if applica le: ✓ ' -'- \:\i <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_ Addn )'Alteration _Repair Type of Project _New _Addn X Alteration _Repair _ <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fi••res <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump 2.. •ilet Backflow P -venter(Inside Bldg) <br /> Forced Air Systems Unit Heater d Ba ub Urinal <br /> Gas Piping Boiler i— Lavat.• (Wash Basin) D ' ing Fountain <br /> . e - _ -r Refrigeration Shower loor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink : Disposal Grease Trap <br /> \Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Ho. ups Other: A Clothes Washer Medical Gas <br /> / Range Hood Water Heater Other: ' <br /> ec 3 Exhaust Fan Sink(Service/:.r/Mop/etc.) Other: <br /> SPRINKLER/ UPPRESSION SYSTEM <br /> (Chemical . ater I No.of Heads <br /> KNOWLEDG ,' NT:I have reviewed this application and confirm the information containe.herein is true and correct.Work done pursuant to this permit must"comply with <br /> curr- -. •,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 /> .11.,-"-----_, j°1-'4.----. 461.- -[& PERMIT# mh90(?), ,,t <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />