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PERMIT APPLICATIO <br /> BUILDINOMECHANICAL/ PLUMBING /SIGNORINKLER/ 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 /> - P_ROJECT-SITE'INFORMA'fION <br /> PROJECT SITE ADDRESS:/&1q <br /> DDRESS /&1q !'`,,,d-. . PROPERTY TAX#:V hy .o q.3 ' 03 &0 '19 00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ' ;CONTA4''T.'INFORMAT�®Al <br /> OWNER NAME: � �� Ylcc`�"1..'�J . TENANT NAME(If Commercial): v a Ct' C- J i✓ <br /> OWNER MAILING ADDRESS: STREET J& I�f c <br /> CITY v��Q A STATE � a) ZIP <br /> I- <br /> OWNER PHONE: LS L S oL ' SZ 3 QWNER EMAIL: <br /> CONTRACTOR NAME: ��/T - i 1-N C-- <br /> CONTRACTOR ADDRESS: STREET L) tJ P <br /> L-A- CITY STATE ZIP <br /> CONTRACTOR PHONE: �(J6 1 CONTRACTOR EMAIL: AUEh SC'eC 'Cr`L' 1p}sA <br /> CONTRACTOR LICENSE#(REQUIRED):.S;67A ' 7,0 1, J '~ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0�1� <br /> PRIMARY CONTACT: D OWNER N<O-NTRACTOR D OTHER(Please Specify) <br /> CONTACT NAME: ✓.4Ve Avv D A t�6--'� CONTACT PHONE: ( '7 ]9� - o (.� <br /> CONTACT EMAIL: �t� ,fc(-Cf i:'e?' •C�,.�. <br /> BU;ILDING'PERM4 <br /> IT APPLICATION <br /> inxisting Use of Building: Lj}=��C tri Contract Price of Work:$ 7'1j12 <br /> oposed Use of Building: Heat Source: Mas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached DSFR-Attached ❑Duplex ❑Multi-Family-#of Units: 060mmercial ❑Industrial <br /> Type of Project: ❑New MAddition GRemodel Eftepair EIT.1. []Sign GSprinkler DDemolition DChange of Use <br /> DESCRIPTION OF WORK: ����{ (r1- e14,0-, .�� Old �i4k- OAJ <br /> �k /C A-4<-,,(re CA�e/,- t/-f g..,,� q4 s- /do¢AL /,1 JA,�,/ /e c,4 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> M'IT LfCATI <br /> MECHANICAL PER..MIT APPLICATION:' PLUMBIN.Cy PE'R APP _ ON. <br /> Type of Project _New ^ Ad _--Alteration Alteration _Repair Type of Project _New _Addn _Alteration _Repair <br /> #of #of #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures <br /> List of Fixtures List of 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 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,/SUPP..RESSI;ON SYSTEM: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 /> rent 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 /> �Iding 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 /> end/comply with the State Contractors Law 98.27 RCW and 296.200A WAC. City of Everett Official Use Only <br /> PERMIT#M w os—,, j Q) <br /> Owner/Authorized Agent Signatur D to (Revised 10/12/2095) <br />