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PERMIT APPLICATIO <br /> � BUILDIN ECHANICAL / PLUMBING / SIGN PRINKLER/ 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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: q 909 N A R13ECK RD PROPERTY TAX#:00V/700OR40202 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: PeTE4.e fredies erte --.4-t, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESSPrIf TREET /''�2/.�'d s S Q Q <br /> CITY SM9//04 '$/l STATE �4 ZIP 9d 9 <br /> OWNER PHONE: *' c 4/22 63.J9 OWNER EMAIL: pe,e.e_s/GP& LovvCaejj/7G.7- <br /> CONTRACTOR NAME: Hwy 4" <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): i CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR (OTHER(Please Specify) 5.4W T <br /> CONTACT NAME: y,9 - ' fy/90X,e44 CONTACT PHONE: -Zoe Z f' 7:329 <br /> .7a07444. .,*QEjfyj _- CONTACT EMAIL: y$ifQc7/y,Ptc eq.€f112 'o. G'Olin <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ �S .0O0 <br /> Proposed Use of Building: 5.' ? Heat Source: ❑Gas ❑Electric DOther <br /> Building Type: ❑SFR-Detached IISFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ONew DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: /.3v/k4, 2. role y /Ytv,,,sz* Ape i. ,4rr J-c41.7 cq" <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATIO PLUMBING PERMIT APPLICATION <br /> Type •f Project: }<New _ Addn _Alteration epair Type of Project: K New _Addn _Alteration _Repair <br /> #of #of #of #of <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixture- Fixtures Fixtures <br /> A . —Air Handling Units Heat Pump '/ Toilet Backflow Preventer(Inside Bldg) <br /> Force. •it Systems Unit Heater 3 Bathtub Urinal <br /> Gas Pipi Boiler Lavatory(Wash Basin) Drinking Fountain <br /> / Water Heate Refrigeration „I' Shower Floor Drain <br /> Gas Fireplace Wood Stove I Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting / Dishwasher Roof Drains <br /> / Clothes D••er Hookups Other: 1' Clothes Washer Medical Gas <br /> Range ood / Water Heater Other: <br /> i3 E •:ust Fan / Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Chemical or Water ' No. 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.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 /> / J r� City of Everett Official Use Only <br /> t� <br /> 7 �6, _i D� t..a <br /> Qi 1 D PER <br /> N�T� O D 1 <br /> OOwner/Authorize Agent Signature T�C� Date (Revised 9/23/2016) ` <br />