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PERMIT APPLICATION <br /> (4rgn- BUILDING ECHANICAL/PLUMBING/SIGNRINKLER/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: 9Z17 Ggit4D A E. PROPERTY TAX#: eo3 Re51-1 I'7 3 O 13 6 C <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 1/4)O4-tI4 Awl) SALLY GtAC TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET �9/2.1/ G-�M D AVE �J� <br /> CITY£V aE. 1 STATE LA A ZIP 9eZo I <br /> OWNER PHONE: "-(Zg) 8_12.97 OWNER EMAIL: ,T=nQ I+116 ®grr,o., i , Ca�1 <br /> CONTRACTOR NAME: 71317 5 r\G U hit s I� y 1, CS 10Y) �J <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: q CONTRACTORy EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): .S R k(..H S C. I o)Z D CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): (0 3311 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 916THER(Please Specify) DES(&ME?. <br /> CONTACT NAME: KikTNEK((\t,E_ CONTACT PHONE: (206) 8 s O -g3Z3 <br /> CONTACT EMAIL: KaH1y4ei rvl CD rvl oa I,e_avV► <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$H 5 l CYO Z 1.1 N LTE, <br /> Proposed Use of Bui dingliaAFA(A E.--(- F(ckliGToRACIE Heat Source: ❑Gas Ll3tectric ❑Other <br /> Building Type: SRF Detached DSFR Attached ©Duplex °Multi-Family#of Units: ❑Commercial °Industrial <br /> Type of Project: L►1New °Addition ❑Remodel °Repair DT.i. °Sign °Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: bEl- L15H EK15T1 t l(A C�At:AC E-• (.,ON,STR<sc- ILL W (IA RAvtE <br /> -r, , _ - �E_,. n ,_ (1 (-rti 2.1`1a S(-aKU oFne S O A E- <br /> -,_-,ram;,..,G �� <br /> ASSOCIATED BUILDING PERMIT#(ifypiicable): ,,�pC�. ems ,t (� ,�p Fe. ) O'vecilarA. <br /> - <br /> MECHANICAL PER APPLI TI PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ do Alterati Repair Type of Project New _Addn Alteration _Repair <br /> Fixtures List of Fixtu Fixtures List of Fixtures Fixtures List of Fixtures Fi#Of List of Fixtures <br /> A/C—Air Handling nits I Hea Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Syste U Heater Bathtub Urinal <br /> Gas Piping iler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater efrigeration 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 /> 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.lam the owner,or lam authorized by the owner of this property to perform the work for which application is made, <br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> /rce6ezez&„"_- • PE T <br /> i /20 z 0.- ( <br /> Owner/Authorized Agent Signatur� Date (Revised 9/23/2016) J <br /> 1 <br />