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4ren. <br /> • PERMIT APPLICATIO <br /> BUILDING / MECHANICAL/PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 Ni 1 to 03-- 0"- _'' <br /> -3 <br /> a-3 --1 L ` I b <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: PROPERTY TAX#: <br /> 142cob,) tit ;: � fi�- 319�t 0 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> �/ i CONTACT INFORMATION <br /> OWNER NAME:f\)a�(ir�i/_ t<Pc ' Ft_.M. V TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET I/-f ,Z (; �r-1 PR, <br /> CITY I(ll t,i r� -/ STATE (;',..^� ZIP 9 g i <br /> OWNER PHONE: /..42_1:;)_1-5e5 - 14 .f OWNER EMAIL: <br /> CONTRACTOR NAME: Li+f?,A 41 tV.. : , Vet 1' t R.fi'- 's <br /> `�(} <br /> CONTRACTOR ADDRESS: STREET ; 41 M b; i — S 1,,..,J / <br /> CITY L'6111 l tASTATE i y.,'C+ ZIP 6 (��7 YJ <br /> CONTRACTOR PHONE: .1rJ6-^ • V)2. CONTRACTOR EMAIL: <br /> S�� � e(?!1 i!i .�� tNY;ciiw11l1iLh 1?a'tix.%':63`c.„:z/1 <br /> CONTRACTOR LICENSE#(REQUIRED): f gk .5 Smoi CITY OF EVERETT BUSINESS LICENSE#REQUIRED: -4 3 <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ^ - , ' <br /> nilAwi © Avt CONTACT EMAIL: Akx .; - <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas 0 Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: OCommercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair CIT.!. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> T <br /> DESCRIPTION OF WORK: 142- 7 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New _ Addn _ AC(teration _Repair Type of Project: _New Addn Alteration _Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> 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 /> j 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 I 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 1 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# <br /> 7 J I Jit l(,D 3 -O � <br /> OwnerlAuthorizeo'Agent Signature Date (Revised 10/12/2015) <br />