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°'- 0 II E RMII II, A�� 6 LICA IO NO <br /> '� GDURAL:M( / ft1R::CHANQKAL./ PLUMBING / SIGN I SPRINKLER/ fL)EMOl 1CION <br /> V? , tioCITY 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 /> (`�'i a or Black Ink Only Please) `PROJI CT SITE INFORMATION <br /> PROJECT SITE ADDRESS:A 7/1 G /9 AvG%. cf, 4 PROPERTY TAX#: Z'g D-1-2.6-}P 20,3"112i1 <br /> LEGAL for new construction: Shod Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: £t.P/Vt/ t,.v/, Aft 7%I/1 f t/0j TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /b34 q J F. 7 c/7,1 ar 4.7, <br /> CITY A a-f L.fp-v v e- STATE* jd i- ZIP ?gad g <br /> 'OWNER PHONE: ----- OWNER EMAIL: tint( <br /> 1 CONTRACTOR NAME: T. -V • <br /> - <br /> 1 <br /> CONTRACTOR ADDRESS: STREET <br /> 1 CITY STATE ZIP <br /> 1 CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> 1 PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR STHER(Please Specify) A--QZC_t--( ("7..t7 <br /> CONTACT NAME: jZ.s,s- J-A-0. .e..1,4..4 CONTACT PHONE: C4 t ) Z S 2 - -z.. I J 3 <br /> I <br /> 1.-e21'Z , LLf"V `Te-C'7'tJtt� CONTACT EMAIL: r-ogr '(ZCu-ck.h.cf-4 ,Lqe,( <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: S t h.-S re t -Ci 4_e kt L t.,. - Contract Price of Work:$ , <br /> &: <br /> Proposed Use of Building: 'r o ..--1, �"tT o Me"- Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached 1:NFR-Attached ❑Duplex ElMulti-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel 0 Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: © <br /> * r IR. or aJ Ir/7_ (2 vIU t? '["ow 1v /'t , vs'' C oM r Lit , <br /> ( --r (N Of, id / b it 4-t _ Y ca. Ail c--Me 3-t_+-t v N./c <br /> ASSOCIATED BUILDING PERMIT#(if applicable): Oil, / t‘,44 f3 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <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 /> . NC-Air Handling Units Heat Pump 2 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems / Unit Heater 1 Bathtub Urinal <br /> Gas Piping Boiler 'Z 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 I Water Heater. Other: <br /> ,__3 Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I ,..... No.of Heads r _ • <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 /> City of Everett Official Use Only <br /> PERMIT# <br /> --.-Pt--47"---‘------ _. .. <br /> Owner/Aut orized Agent Signatu'e Date (Revised 9/23/2016) <br />