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PERMIT APPLICATION <br /> (4•'Vd---4 <br /> BUILDIf MECHANICAL I PLUMBING I SIGN —RINKLER I DEMOLITION <br /> CITY OF EVERL I I PERMIT SERVIC <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-$810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> H F s - <br /> PROJECT SITE ADDRESS: <br /> )%01 pa I(e -' Ave- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of tong legal description) <br /> . .._.:• •::...... a:. <br /> OWNER NAME: AndreA Ck0t'7 V\&.c . TENANTrNAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET I�/�()�/e,' �ci� V6 <br /> j � �t� A <br /> on, FV e I h i STATE W t'/t. zu' . <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME:�77 rks plumb Mb � /�j <br /> /� <br /> CONTRACTOR ADDRESS: STREET I-38 '� j4 V` DDP__ r <br /> c 1 l I k STATE zIP el Z 23 <br /> CONTRACTOR PHONE s p7G; - - CONTRACTOR EMAIL: a/45 phA 0,,‘l J , <br /> 1,CON. <br /> CONTRACTOR LICENSE#(REQUIRED): PAP-Ks PH 01 JO 17CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 047 <br /> S 6161. <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 42-6 e 50 1, els 5 Co <br /> .. e..4--c- _ DQ U\S CONTACT EMAIL: <br /> ;......,--.. ..:_s_.--_ ,_..may:}�.a.s.ez-s..>.ksu+_ .-e•'�.z-�-e:_,��'�-=v�an�:�r'=-.:v,2�Ti_.�3,."I--:d:�f��v,_--e'ii:_T;�-'{;�-,•-'.:'..r,:•'.��.t ::_.. : : <br /> --._. ..-.-.r. .__�_-.�«�:�_.;.s..-��:pry'.... . ... _...�:��':. � ,B,U�'D11N�PER11�1� r�.1 .�. <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: CI Gas ❑Electric ElOther <br /> Building Type: DSFR-Detached I:SFR-Attached DDuplex DMulti-Family-#of Units: EICommercial 0 Industrial <br /> Type of Project: ONew GAddition DRemodel EIRepair CIT.!. ©Sign DSprinkler Cl Demolition DChange of Use <br /> DESCRIPTION OF WORK: <br /> rtiolAc-c at 1Gfckyt ct IA,� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> . :r.1.:0 :.:.—.-_.A:,-....•_- , ' - "_--_. -' _ :.:..,.../PLUMBING.PERMIT:.APPLICATEO.N. <br /> '�:� ;'�MECHANiGAL PEfit1�111_TAPPL1tiQTCC�N�=�;..;: .. <br /> Type of Project: ,_New^ Addn _•,_Alteration Repair Type of Project: New _Addn Alteration Repair <br /> #ofList of Fixtures #of List of Fixtures <br /> List of Fixtures #of List of Fixtures #of <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 I 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 /> :.;;A:.:•$00.44.00S/ UPP;RE'S' 1bN"S1.0*. I ::'_= <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 tam authorized by the owner of this properly 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 /> / <br /> CPERMIT# � ( OOo(0-- lOrL <br /> Owner `uthorized Agent Signature Date (Revised 10/12/2015) <br />