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. • <br /> 014reEITPERMIT APPLICATION <br /> BUILDING/ 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 J(E)everettepsceverettwa.gov i www.everettwa.govlpermits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: t rcy ?! '_ , I PROPERTY TAX#: <br /> ZL 1—►�SCC � h 1NL► <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Ph;1 z pctd;3n in ¶4 11Jt•.;1d(j'; f) ��AANT NAME(If Commercial): ( Lee mayl{ V:ija � <br /> OWNER MAILING ADDRESS: STREET C4 t, ma I <br /> . CITY Mar;yia d 1 Ry STATE Ca ZIP ch9?q2 <br /> POOWNER PHONE: ' ®-?70—Fq 7 S x.1..,_5"- 'OWNER EMAIL: <br /> CONTRACTOR NAME: (p1'14' mar t <br /> CONTRACTOR ADDRESS: STREET 3 1./14 l], C4., Ki.*,i $ 4-, <br /> CITY A,,, r•n STAT[ w ZIP °jd'601._-- <br /> CONTRACTOR PHONE: ?53- Z1 -3. 7$ CONTRACTOR EMAIL: "S-0,c4:", P,r,,t (r? c�. .„ ?plc,,-It,cool <br /> CONTRACTOR LICENSE#(REQUIRED): Gil*('i der WZ CITY OF EVERETT BUSINESS LICE #(REQUIRED):oc(Y6011 <br /> PRIMARY CONTACT: 0 OWNER (,CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 706_„ •-c Rs _Ih 4,1 co n r <br /> a�•rc :n .'4,..(c.,..1 <br /> � <br /> Flare).' _ CONTACT EMAIL: a-rc.. :✓,aO}�rJ'r�{t�D{r�0,04;rYictrk.Cd <br /> 41 <br /> - BUILDING PERMIT APPLICATION ` 'j <br /> Existing Use of Building: Contract Price of Work:$ t ,yqt.46 <br /> Proposed Use of Building: Heat Source: ❑Gas 0 Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑industrial <br /> Type of Project: ❑New ❑Addition ORemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ODemolition ❑Change of Use <br /> DESCRIPTION OF WORK: S•1 le ki°ee... 0Verlay, We w-;)l .'1n5+af)',z4y„n D603 1i—k t'iechlt j <br /> c✓tec,I C6I I mechan;cal ty PS ed• 20 year- W r er4y <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 #°f List of Fixtures #of List of Fixtures #°{ List of Fixtures <br /> Fixtures Fixtures 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/Mopietc.) 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!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> !r PERMIT# <br /> n” — , ' 77 �.r horized A•` Signature Date (Revised 10/12/2015) <br /> 1=, <br /> l/cQ, <br />