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PERMIT APPLICATIn�' <br /> #111/10Ibi./111L111 BUILDIN MECHANICAL I PLUMBING I SIG PRINKLER I 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 I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE A DR SS: 3312) Sr- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> c <br /> CONTACT INFORMATION <br /> OWNER NAME: 0ei/f J /� /10� A/GiSkelfD TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET es 7/(p 53Ri) S7 ///� <br /> CITY veZ -3- STATE Via 1 <br /> OWNER PHONE: 11i5' 354?-- 36:7V2.- OWNER EMAIL: <br /> CONTRACTOR NAME: =/V/CR. 5 cJI C,(i-:;"- Le,Kre& L LC <br /> CONTRACTOR ADDRESS: STREET /c/to 3 7 Cej,4X_ J2.) <br /> CITY &Ale-Qi STATE /1 ZIP p egyft5 <br /> CONTRACTOR PHONE: el2f-s"76-(7/3,E,S CONTRACTOR EMAIL: <br /> c <br /> CONTRACTOR LICENSE#(REQUIRED): O 5) 9 p CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER ,ONTRACTOR 0 OTHER(Please Specify) <br /> CONTA. NAME: CONTACT PHONE: 2 ' - <br /> cze') /X6` entA40a=(Z CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: _Contract Price of Work:$ I CI60, <br /> Proposed Use of Building: Heat Source: Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair DTA. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> X14 rroe\l OF rbc— fir' m1-67-Tc)"-R---- <br /> ASSOCIATED <br /> ''.67-T`- - <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <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 #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures 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 /> SPRINKLERITSUPPRESSION:SYSTEM <br /> Number 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--, circumstance.lam the owner,or lam 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 ./7 RCW and 296.200A WAC. <br /> .°'''2 // , <br /> City of Everett Official Use Only <br /> PERMIT# <br /> ill' --‘ /( 1 --/_J ---- I 1 I' dd--I. <br /> Owner/Authori d A.-nt Signatur- Date (Revised 0/12/201 ) 55 fi <br />