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.'''' •':'',;:v7 0 If'k:.V4.M 0"i AP li:'L.I C AT I C. <br /> `�. DIM...DINGG / 0l4I1Z._C::,HANiCAL 16°'LUdt><0[PLUMBING / SR N9 / SPRINKLER I [)0 W000..,0'II ON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 44.1rE13/1-e7 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=lane or Black Ink i)rrily Please) IPRCJIECT SITE I IFIRMATIO�`I — - <br /> _-- <br /> PROJECT SITE ADDRESS: /O'Z,3 $ /9 '? ,'L'7. ci. PROPERTY TAX#: L'g o j"j Zo,3 e� <br /> LEGAL for new construction: Short PlaUsubdivEion Lot No. (attach copy of long legal description) <br /> CON TACT INFORMATION <br /> OWNER NAME: L4"A f v//) ¢ 7)4'. j4.' TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /b3D q J F 77. <br /> / <br /> coy y�r G�. STATES �i ZIP g�f(� <br /> OWNER PHONE: OWNER EMAIL. t st ✓g p yt,t Q, �, c, <br /> 1c0NTCT0RNAME: <br /> RA ��, <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIR ): <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR MOTHER(Please Specify) }-( ( lc <br /> CONTACT NAME: tZ�s,r a CONTACT PHONE: Z.� 2SZ - r 3 <br /> L CONTACT EMAIL: r-• <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: S t h.S le i t-c i��-e j L, . _ Contract Price of Work: $ <br /> Proposed Use of Building: T o t� Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached FR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: D <br /> ASSOCIATED BUILDING PERMIT#(if applicable): �j (,'id—ii <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATIO <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 2 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems j Unit Heater 1 Bathtub Urinal <br /> Gas Piping Boiler 2. Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration I Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen S nk&Disposal Grease Trap <br /> Gas Range ; Ducting Dishwasher Roof Drains <br /> / Clothes Dryer Hookups Others I Clothes Washer Medical Gas <br /> / Range Hood 1 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 <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 /> (\ .‘ t-4 — — - PERMIT# _ (g'o 3 -D <br /> Owner/Aut orized Agent Signatu-e Date (Revised 9/23/2016) <br /> V..., <br />