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• PERMIT APPLIC <br /> BUILDING / MECHANICAL/ PLUMBING SPRINKLER / DEMOLITION <br /> #11111d:::‘ <br /> *IldiCITY OF EVERETT PERMIT ilr ES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: r PROPS TY TAX#: <br /> h7 fj i!c/L'Y �Ic1 // t tip- } <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ( I 10CTENANT NAME E(If Commercial): Z a7 nS (/ i_,..,Yl <br /> OWNER MAILING ADDRESS: STREET �j D 7 �`t- f:v`P/i -1 fL-0,-,"�� <br /> CITY '—E/) flit,l STATE ZLA?�`'Jd— ZIP 7 V�/r� -7--.1 <br /> OWNER PHONE: Z 1 V ji OWNER EMAIL: Cie.I 5,(C DV 1' (2 f.J ctyha i), L _, <br /> CONTRACTOR NAME: Go1i i'/.e..._ S 8-yl s <br /> CONTRACTOR ADDRESS: STREET 5—( U 7 „evil. Cf,-. if k yt <br /> CITY L-yl/)/1 tAi c o q STATE WAZIP (cc CONTRACTOR PHONE: X29 — 7y--07 6 oICONTRACTOR EMAIL: w (,r i 1-.e S i 0 C.)? ah c+.--„Pi t ay'^' <br /> CONTRACTOR LICENSE#(REQUIRED): 14'H I%f t4, 17 6 c---3 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 424- — 76 ?6 'c> <br /> 0 y CONTACT EMAIL: vy(,l;-f-:Q S'i 5�,,1 00 2 g C�-yt1—' I.�a vLSlvt— <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ /> (25 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: I:New DAddition DRemodel DRepair ❑T.I. OSign I:Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: f f t ^t n fat _ i i/o PI&f,g Att.4 yyL,'y) 044-1 5 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 #of #ofList of Fixtures #of List of Fixtures <br /> List of Fixtures List of Fixtures Fixtures Fixtures <br /> Fixtures Fixtures <br /> NC—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 /> 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 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. City of Everett Official Use Only <br /> 'rt' l,. � PERMIT#. 3(7 1 /6 St(at 3 z <br /> —00 <br /> 1 to (Revised 10/12/2015) <br /> Owner/Authorized Agent Sig ature \ 12- <br /> . <br />