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PERMIT APPLICATIO BUILDING?MECHANICAL/ PLUMBING /SIGN / PRINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES • 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS:'°* - Cep 1-4---- ( PROPERTY TAX#: (pS6 St-- LEGAL for new construction: Short Plat/subdivirllZ 2 n (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: j, -5- Ca 2 Le TENANT NAME(If Commercial): ‘-.t1 vc-c v't k , OWNER MAILING ADDRESS: STREET {11 LZt - 1tt .(t'� tom) // CITY ^a 5 `k CJ STATE (3 ZIP 9�Z- OWNER PHONLe�(;) 321-- 1 ei\ OWNER EMAIL: "17s..,Li, p jo„ ,,e,,„>ti- CONTRACTOR NAME: ��\V G. �►v..,V`` Ali , 2 `�, 6 CZWI CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR CQTHER(Please Specify)-ter—,',t' 1 r- 4---Mll)L►.._ J CONTACT NAME: 1 �"� ,_ _ CONTACT PHONE:2.(o ` ^3 1 1,S n�/� �� CONTACT EMAIL:'.),Ai_e_�'\t l R L( .. t l • CC,,,c~—A,.. . BUILDING PERMIT APPLICATION r Existing Use of Building:'' �4, L_ Contract Price of W k:$ Proposed Use of Building: K- L JeS 04--L-41'5 Heat Source: ❑Gas loe#++e ler Building Type: ❑SFR-Detached FR-Attached ❑Duplex ❑Multi-Family #of Units: ❑Commercial ❑Industrial Type of Project: ❑New ❑ dition PfRemodel ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WOZ -t 4e CA2,J 11.�JJ , A\I )-4c.4.e Pe-- ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New_ Addn _Alteration _Repair Type of Project: _New Addn _Alteration _Repair #of List of Fixtures #of List of Fixtures #of List of Fixtures #°f List of Fixtures Fixtures Fixtures Fixtures Fixtures NC-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Urinal Gas Piping �Boilerr. ( Lavatory(Wash Basin) Drinking Fountain . rR Water Heater efrrgeration I Shower Floor Drain Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap Gas Range t Ducting Dishwasher Roof Drains Clothes Dryer Hookups Other: \ Clothes Washer Medical Gas Range Hood Water Heater Other: a Exhaust Fan t Sink(Service/Bar/Mop/etc.) Other: SPRINKLER/SUPPRESSION SYSTEM Chemical or Water I No.of Heads • 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 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 Building Official before being uthorized 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, and I comply with the State nt ctors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only C. 411c PER(__j # V Z W� wner/ uthonze Agent igna e Date (Revised 9/23/2016) 4 Ji