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4rETT PERMIT APPLICATION <br /> BUILDING I MECHANICAL! PLUMBING I SIGN 1 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 ((E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> gggmortBSVRSMNFERgimngggg?oko.-E:o*toljR'Rtit*Atiti-iGMSISISENMESGEIMMEBSMPg <br /> PROJECT SITE ADDRESS, PROPERTY TAX#: <br /> 6001 Fc_git T <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ggaitaitibfgatibikAAWRISIMARtgadONTAOTINFORIOtIOICUIAMMERAIRIMMESMISMagra <br /> OWNER NAME: 7/77 C j I PVA-cif TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 6'C'O% / ' $ y <br /> CITY /5 U 1-F STATE (/id zip Z4:7 3 <br /> OWNER PHONE: 3( --24 5.1 O4 OWNER EMAIL: <br /> CONTRACTOR NAME: <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: JI OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: Vf7-itUy pop,fCir CONTACT PHONE: 3'O ?, <br /> CONTACT EMAIL: t/y7A- /CH'0. /tPr /M LO,:Elerataaae.-F.MgnatggaaNiatttVlgt;idZOEithIUTPAI*k*AtlP.NOP;:MrtkagaSgigtga45gMb.WatggQSLICATION <br /> Existing Use of Building: 5 Contract Price of Work:$ 4'7O <br /> Proposed Use of Building: S Pi&. Heat Source: ❑Gas ❑Electric El Other <br /> Building Type: I]SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ©New DAddition (,$Remodel . DRepair CIT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> lJ01-10 CA-g,.POr-i Dec& <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> hate_MECHANICAUPERMiT;APPLICATION; hataightig#14ggitttgiRlgAMITIOPUPATISANteitddinagig <br /> Type of Project: New_ Addn Alteration _Repair Type of Project: New Addn Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-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: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> ag SPRINKLER-!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 aut rized 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 C r tors Law 18.27 RCWand 296.200A WAG. <br /> City of Everett Official Use Only <br /> PERMIT <br /> r- I <br /> / Zd /7 l W (103- DO I <br /> OwnerlAuthori Agetit Signature Date (Revised 10/12/2015) <br /> ll <br /> 3 <br />