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1 <br /> PERMIT 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 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: PROPERTY TAX#: DO 'y f 0 '-J(oD <br /> LEGAL for new construction: Short Platisubdivision Lot No. (attach copy of long Legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: &A N 4-')R 4PE2. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET -r.r Q.0 <br /> CITY STATE <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME hC• I <br /> I <br /> CONTRACTOR ADDRESS: STREET )-74e 241 S-14- AtA_0 12E I WA <br /> CITY () STATE IJ/4- ZIP <br /> CONTRACTOR PHONE: �s'� �Q�j`— W// CONTRACTOR EMAIL: stoma @CB1-ri2tS{�-r,Q • ��rt <br /> CONTRACTOR LICENSE#(REQUIRED): C0j2fJEf2r022C� CITY OF EVERETT BUSINESS LICENSE#(RECIIiiREO): 033S-6 <br /> PRIMARY CONTACT: O OWNER CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: /� nn CONTACT PHONE: -206- - 70(0 —�'�•y / <br /> CA4 6 M/ E,00— CONTACT EMAIL: <br /> C�.t' Q 09-rtarC4y,Q <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of B tildin.: (e /1s2,0t`o(ta) Contract Price of Work; $ J�/ SOry' 00 v <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Ocher <br /> Building Type° GKR-Detached ❑SFR-Attached -,,..E]Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of P ❑ ❑ ❑ m ,,.5tt <br /> roject: New Addition Re <br /> odel t4'epair ❑T.I. ❑Sin OSprinkier ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> " <br /> ASSOCIATED BUILDING PERMIT# if applicable), U V <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #o/ List of Fixtures #°f List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> AIC-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) f <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 j <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. <br /> City of Everett Official Use Only <br /> PERMIT t <br /> 0/ <br /> OwneriAuthorized Agent Signature Date (`Revised.512012016) <br />