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4rerrPERMIT APPLICATION <br /> BUILDINt�AVIECHANICAL/ PLUMBING /SIGN ) SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: Zfc' / w' 17‘ PROPERTY TAX#:00 S iia(-4.SSdo 900 <br /> LEGAL for new construction: Short Plat/subdivision5e.# /Am./6 2' P Lot No. (attach copy of long legal description) 5& <br /> CONTACT INFORMATION <br /> OWNER NAME: 444,4,0 J7 �t✓� 4:e"." ,/ <br /> TENANT NAME(If Commercial): .�— 4/l4- <br /> OWNER MAILING/ ,ADDRESS: STREET Z5//XL ""€ i 'moi' <br /> /l, CITY ���C� STATE ZIP 96 / <br /> OWNER PHONE:G7? Z'S S 9 3 ' OWNER EMAIL:GJE4,1c/4-9' e.Li.l.,z "tog—ro/wN-?4 /Aicfay.ccM <br /> CONTRACTOR NAME: C,‘,.../Ale <br /> CONTRACTOR ADDRESS: STREET .0 or-.—l/E_ <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: IER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: t/2 Z56-'934.1. <br /> �✓ E 5fe. CONTACT EMAIL:,) 4*L•,"e�„d,� ���Mr.�/, ��G`�ev.CC'/� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 0.42, .4 04----/•-•^1-*--/�3 Contract Price of Work:$ <br /> ./ <br /> Proposed Use of Building: Heat Source: ❑Gas El Electric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex gtriAti-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: ❑New DAddition DRemodel ❑Repair ❑T.I. OSign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 72., ' //t.. •X-7 s 74i:.. 5--•6Q. ;.--i--' _ rs .. , /- <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 /> 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> —� City of Everett Official Use Only <br /> PERMIT#-D) 1oD S - l0 <br /> Own- uth.•went Signature Date (Revised 5/20/2016) <br /> �,.. RC2 <br />