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• <br /> t ''rr //p 1 II pp ( [� ii /. <br /> r,.. •.t I� l� t a 1� I_'9 e SIGN <br /> e� Yl I r .� <br /> r <br /> mJ L''JINNG / G�iilECHAAN1CAL 16- p..-�..D1MBING I S / ok'RINNKL.[ R/ I..)-MOI...I'I ION <br /> ___ CITY OE EVERETT PERMIT SERVICES <br /> ' . .1,74/!I 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 /> ([due or t:lack Ink Only Please) PRLJ CT SITE IE.�FOt';MATION _ — - — 1 <br /> PROJECT SITE ADDRESS:/�7 2 S' A A. /9 147 ,r _7• cf.. j PROPERTY TAX#: 7,e 4,S"245e;e)Z,o,3 41,04 <br /> a LEGAL for new construction: Shod Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> i <br /> OWNER NAME: WW1 diL.v//V 1 714/f WOO TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /bgo q J F 7 it, c17/2.r►e7, <br /> CITY A a-LL.(�v.v STATE4 1.4.... A- ZIP ?goo <br /> OWNER PHONE: OWNER EMAIL: t t •/ <br /> CONTRACTOR NAME: T. '& _17. <br /> CONTRACTOR ADDRESS: STREET <br /> I <br /> CITY STATE ZIP <br /> (CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR STHER(Please Specify) f4z c --( ( T .C"T' • <br /> ?CONTACT NAME: t2-65-s' Lr']6-rv,,,..S a CONTACT PHONE: C4 v ) Z S z . z I '3 <br /> 2-&1 r'7. kn.c l-t1 `71 r .c:-/-C Qs. .c. CONTACT EMAIL: r +SS ( 't-'1(ZG r.t-c -.'1".L CJ-c, -t .C-tev7 <br /> BUILDING PERMIT APPLICATION <br /> , I <br /> Existing Use of Building: c if it-1 to /r)t-f i.df-e"H t_ t,.. - Contract Price of Work: $ <br /> Proposed Use of Building: r o - N /-1 0 AA € Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached 1'FtiFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 0 rIturoJc07_ (2 vki 1 T I4:3w lv Ha vS''IC- Coet t t.4? X, <br /> L►. / (tJ n t Id i D te 44.__ r ca. An ( 7J irc.4 A. -C -c v N 1.7 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): , lid, '- .s <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 #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC-Air Handling Units Heat Pump 'L Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems j Unit Heater I Bathtub Urinal <br /> Gas Piping Boiler 2. Lavatory(Wash Basin) Drinking Fountain <br /> I Water Heater Refrigeration 1 Shower Floor Drain <br /> / Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range ; Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Others 1 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 1 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/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 /> OwnerlAut orized Agent Signatu e Date (Revised 9, 2016) <br />