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04-17 PERMIT APPLICATION <br /> BUILDING ECHANICAL / PLUMBING / SIGN i.----RINKLER / 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: 114- (,.3 ((��LOIS Lail O f? / PROPERTY TAX#: OO 86, 4039 <br /> & I Oci <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: t ? J\ v-A� M04i6., ANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET +2-2-( S-6. ((X)O <br /> CITY h/LC\a_S STATE TX ZIP <br /> OWNER PHONE: OWNER <br /> �EMAIL: �( <br /> • <br /> CONTRACTOR NAME: f"Q& - '"p�(_ t� �(vv i '£ I ` -€- Yl'UK 1 &(( oY1S <br /> CONTRACTOR ADDRESS: STREET <br /> { It <br /> CITY ` S I I STATE V - ZIP q$2--C.) <br /> CONTRACTOR PHONE: <br /> 'v(GU • (s - " SCY� CONTRACTOR EMAIL: j 1'1 f0 pA.)112-A-VvAke_GLh 0.0( <br /> •�'Q�It�-�' <br /> CONTRACTOR LICENSE#(REQUIRED): 1 F�F``� � A CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): C J`)>C) <br /> PRIMARY CONTACT: ❑OWNER L1CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: 3( <br /> n CONTACT PHONE: QO . �� . `j smU <br /> v,�1� _ c KQ,��I��� CONTACT EMAIL: 'l tcyfb p2 - k.eich.Ylp\. ow() <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ 127-l-'O <br /> Proposed Use of Building: Heat Source: , Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached pSFR-Attached ID Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: I/ <br /> L M- jj``,,- - - lit„C(� F <br /> 4 -4-r <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 #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> I 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 <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 l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> MID'g-,0a3 <br /> Ownerikuthorized Agent Signature Date (Revised 5/20/2016) <br />