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PERMIT APPLICATIO <br /> BUILDIAMECHANICAL I PLUMBING I SIGN RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 477 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: 62.6 t It'll SC 2)3 PROPERTY TAX#: 2_86 Si 1 ooS 029)0 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> + <br /> CONTACT INFORMATION <br /> OWNER NAME: L. t-C U DE part-t-?- V'tUA-Li CJENANT NAME(If Commercial): Illope .. /1O4t - <br /> OWNER MAILING ADDRESS: STREET�"742.G e ,'7`'' sr cur r- r <br /> _ <br /> CITY /11 icE e.. 1 I S STATE ZIP 9. <br /> OWNER PHONE: qtr.' 94If - f3(42� OWNER EMAIL: '�"Edt=.fr✓' j,+„,.7-tf�►ft-k CI-if E 'V !!��e0AA <br /> CONTRACTOR NAME: Rkj NI j ,"— S' tvC113 jj j..L L. c. " <br /> CONTRACTOR ADDRESS: STREET 714 Ut, 6 Z St. SUiTE 28 <br /> CE? /Vle1. JL-el" STATE tk ZIP l B® <br /> CONTRACTOR PHONE: / "2- - 28 j .-6.�� CONTRACTOR EMAIL: T� <br /> CONTRACTOR LICENSE#(REQUIRED): ft.��t z J * CITY OF EVERETTL #(REQUIRED): 5(C <br /> PRIMARY CONTACT: ❑OWNER '6CCONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 25 — [ _ 66 2, <br /> CH fit C/eo rL CONTACT EMAIL: ON I_ \( c 1 .Co/ice ` <br /> BUILDING PERMIT APPLICATIO <br /> N <br /> Existing Use of Building: Contract Price of Work:$ $ f OOO <br /> Proposed Use of Building: Heat Source: DGas DElectric DOther <br /> Building Type: DSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ClAddition DRemodel DRepair ❑T.I. DSign ❑Sprinkler DDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> I NsTFlru-A--7d� o Neu-) Nt�-►Ur-�-cav , ticnde- <br /> low Ex ts-rz,-)ems <br /> 51.40 <br /> - II,J MFr i. t-tore PA C0146 De- A -1i <br /> ASSOCIATED BUILDING PERMIT#(if applicable): A't.QIJ[a IA-ant ST�oS f SO U"" �- <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn _Alteration _Repair Type of Project: _New _Addn Alteration _Repair <br /> Fixtures of <br /> List of Fixtures Fixtures List of Fixtures #°f List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler 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 Water Heater Other: <br /> 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.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I co ly with the State Co tors La .27 RCW and 296.200A WAC, <br /> City of Everett Official Use Only • <br /> PERMIT* I <br /> 0 /A orized Agent Si ature Date (Revised 9/23/2016) <br />