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® •PERMIT APPLICATION <br /> BUILDING • <br /> / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ 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 /> t014. a.r I I ck k.I(0.fl.y;Ple,Oej PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: :.- (�L1'i�`( ()I 3* PROPERTY TAX#: OO 6-l. 0O /c(C ) <br /> 1 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: /f 7't FrO Or-4-)cs `,2,( TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET' i3OZi7 ,T6d ,Uri /1 <br /> CRY j OG:,.1// STATE(/`% zif82 7 <br /> OWNER PHONE: OWNER EMAIL: frr)f ftoTOr-f ies z--[ �y,,,�t/„ C _ ,. <br /> CONTRACTOR NAME: ( _,)r'vrj-- <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify)i t C. A-4-- ,ttf°,7-r- <br /> CONTACT NAME:Ain/ 5:60.ci r,f�/ yL :. CONTACT PHONE: ?..„05 - q 5 Z. -(// / <br /> CONTACT EMAIL: A-/r>(I y( e-c , C'-13Nl <br /> iai;ii::.:.... BUILDING.PERMIT APPLIOAt T ON <br /> Existing Use of Building: .5"Fe Contract Price of Work: $ 30j0 <br /> Proposed Use of Building:S P-R Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: OSFR-Detached DSFR-Attached ❑Duplex ❑Multi-Family-#of Units: El Commercial El Industrial <br /> Type of Project: El New ❑Addition El Remodel El Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: rce/.'1c, -e_/ Nrat1S‘'.- /idz!rs.z !- fG>5 (,�.�I-+� jc) - � '�.c 7 .'C 1/f{ 7y�( <br /> n;.1-('k.M. C-N-.K i/ /Li <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL.PERMIT APPLICATION I' ......:. .. PM.UMOIItlGPERMIT APPLICATION::::>`. <br /> Type of Project: _New _ Addn 4Alteration _Repair Type of Project: _New Addn / Alteration _Repair <br /> #of #of List of Fixtures List of Fixtures #of List of Fixtures #°f 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 I Refrigeration I Shower Floor Drain <br /> Gas Fireplace Wood Stove I Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> I Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER:/SUPPRESSION SYSTEM <br /> Chemical or Water ' No.of Heads <br /> ACKNOWLEDGEMENT.1 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 /> rd off-0D3 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) ylz....._ <br /> *is <br />