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III • <br /> 041Err PERMIT APPLICATION <br /> BUILDING I MECHANICAL I PLUMBING I SIGN I 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 I(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:/,15 Hr, t .Ve - 1 r✓f _PROPERTY TAX#:apt/3.763-� bi 7 <br /> LEGAL for new construction: Short Plat/subdivision Llt v IS J /tx.4 376 Lot No7+S (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> TENANT NAME(If Commercial): <br /> OWNER NAME: � _ AY�ll�. ����� j�j''+�T�7j4 .�' <br /> OWNER MAILING A RESS: STREET /;0T /i1 7)n t p <br /> -,-3 ZIP "M [. <br /> CITY ��'�" I� j. STATE �"T. <br /> OWNER PHONE: t"60 Z/3— � k OWNER EMAIL: `4 1( `.�3. i(, C% . <br /> CONTRACTOR NAME: Aby YiL E&s i1 re ,y`--L� <br /> CONTRACTOR ADDRESS: STREET!t r /O-- ,.jf-e . 3CITY /�� <br /> /d� STATE ZIP C� /Z. <br /> CONTRACTOR PHONE:N )71, — � 7 CCONTRAGTOR EMAIL: ' fa' I ,9i41ai <br /> CONTRACTOR LICENSE#(R IRED): i4 <br /> i- NTAki33I L I— ICITY OF EVERETT BUSINESS LICENSE#(REQUIRED): f' <br /> PRIMARY CONTACT: OWNER 0 C RACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: ' PHONE: (3 z/'3 72 [ 7 <br /> Q r. CONTACT EMAIL: . s E1,1'� (� f 1 �.x K . <br /> C..�f 1CONTACT <br /> ��di�c� �:1� % <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: , Contract Price of Work:S pa, <br /> Proposed Use of Building:��,j(�� 1 <br /> Meat Source: OGas lectric °Other _ <br /> Building Type: OSFR-Detached� R— ❑SFR-Attached uplex t3Multi-Family-#of Units: C1Commercial 0lndustrial <br /> Type of Project: Eitvew °Addition °Remodel ❑Repair DT.I. °Sign OSprinkler °Demolition (Change of Use <br /> DESCRIPTION OF WORK <br /> /kvi duplex cMstruCbdvi <br /> ASSOCIATED BUILDING PERMIT#(if applicable): , <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project %/Few T Addn Alteration Repair Type of Project: %!Few Addn Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump 6 Toilet Backflow Preventer(Inside Bldg) <br /> I Forced Air Systems JUnit Heater q Bathtub Urinal <br /> 4 Gas Piping Boiler b Lavatory(Wash Basin) Drinking Fountain <br /> 2 Water Heater , , Refrigeration Lj Shower Floor Drain <br /> Gas Fireplace Wood Stove 2, Kitchen Sink&Disposal Grease Trap <br /> 2. Gas Range Ducting 2- Dishwasher Roof Drains <br /> Z Clothes Dryer Hookups Other: 2, Clothes Washer Medical Gas <br /> 2. Range Hood ^ ./ Water Heater Other: <br /> 4, Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION TEM <br /> !Chemical or VNatei o) • e ,,( <br /> � v <br /> ACKNOWLEDGEMENT:I have reviews this applicati air(d nfirm the information contained herein is five 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.lam the owner,or am authorized by the owner of this property to perform the work for which application is made, <br /> and►comply with the State Contractors Law 18.27 RCW and 298.200A WAC. City of Everett Official Use Only <br /> PERMIT# <br /> Owner Owner/A�ed Agent S_g tune Dat (Revised 9/23/2016) <br />