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4rEETTPERMIT APPLICATIOI` <br /> BUILDIf\> -"IECHANICAL/PLUMBING /SIGN $ INKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES t'3 I <br /> 3200 CEDAR STREET,EVERETT,WA 98201 P 1 4a --p06, <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMAT0ON. . • <br /> PROJECT SITE ADDRESS: PROPERTY TAX#: <br /> Icia I/I46/AAA Ayr <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> _ <br /> CONTACT INFORMATION: <br /> OWNER NAME: f).-61,4/4i/9 a/ J`r(d,e. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /I }Q t///f 6 yi 1,4 4 t/ie. n.� nn� <br /> CITY ti/f.-//E rr STATE ZIP /61 '2- / <br /> OWNER PHONE: 1- ' l sc , 09"/ OWNER EMAIL: <br /> CONTRACTOR NAME: (,VOL,ft lv 4 r`,.,4 llcA pit J- <br /> CONTRACTOR ADDRESS: STREET /6 3l f /09114 4 y /1/6 <br /> cm WOO )/1/ 11/ i..(/C STATE ZIP 9 -2 <br /> CONTRACTOR PHONE: 92,q 354 072_2 7 CONTRACTOR EMAIL: /9/94/7 0//ot fit Ara lireiet_• CO/I <br /> CONTRACTOR LICENSE#(REQUIRED):WCL Fir. H 5O.q/L CITYBUSINESS LICENSE#(REQUIRED):0 C 7-23 a <br /> OF EVERETT <br /> PRIMARY CONTACT: 0 OWNER ,4"6ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: H.4 3 5 9, 0 3 2, 7 <br /> 10/t Q 1110G-i/1 CONTACT EMAIL: A fh, /�.'1 /vot iirl!/j,97sce cA% >21•<co,/ <br /> '-'.1.','-::,4:'i.: :; <br /> BUILDING PERMIT APPLICATION ..." <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex OMulti-Family-#of Units: OCommercial Olndustrial <br /> Type of Project: ONew [Addition [Remodel [Repair EIT.I. OSign [Sprinkler ODemolition [Change of Use <br /> DESCRIPTION OF WORK: ,Fi tr let' uq ron i we r40,1 t2 E 7E. YC 110v...r E <br /> 9 Pi d r 5d WWF+Tt / stOE k <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> . MECHANICAL PERMIT APPLICATIONr'_: : ;. PLUMBING PERMIT.APPLICATION <br /> Type of Project: _New^ Addn _Alteration _Repair Type of Project: _New _Adds _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 /> NC-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: )i) -f D I./.4j1C, <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> _SPRINKLER:1 SUPPRESSION SYSTEM :. <br /> Number 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.lam the owner,or lam 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 /> a-:14 PERMIT v ( 4 02.7,0 0, <br /> Owner/Authorized Agen ign Date (Revised 10/12/2015) <br />