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14trr PERMIT APPLICATION <br /> BUILDING ECHANICAL/PLUMBING/SIGN RINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVIC <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PRR92. <br /> jECJ ITE 6DDRRE .) �V <br /> LEGAL for new construction: PROPERTY TAX#: ���� �� ��� <br /> Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> 4 CONTACT INFORMATION <br /> OWNER NAME: 1es De.GYu►IGv : fi t_31/14_p__. <br /> OWNER MAILING ADDRESS: STREET 2:2...b . leD1(J3Cft1 Me, <br /> CITY E �el �J STATE WAN, ZpP2D' <br /> 9 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: —6 be. el edit A <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 1 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) 0€619nek <br /> CONTACT NAME: ., -- ?2 CONTACT PHONE: q2 41 ✓ tic>It,PV. CT"( Q( , i a 1k�dQii)Oe7CONTACT EMAIL: kh wie - y te <br /> e.eayth'1 nknet <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: GF Re 3I4€t c�e- Contract Price of Work:$ 11 . L 4-t"Ci <br /> Gc t <br /> Proposed Use of Building: <br /> Re� �Y)G�. Heat Source: ❑Gas '�lectric ❑Other - <br /> Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New \ddition DRemodel ❑Repair ❑T.1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: AAA ,00,5 •{_I. <br /> t-- e�paex3 i,„4...,n- cm r.i•f..1 . incirne <br /> fce <br /> be. elr Wheels ?i v e, - F..,--- =.._ === _ ._-— — ---- -- -- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New AA Addn Alteration Repair Type of Project: New Addn Alteration Repair <br /> #of List of Fixtures #of #of List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures - Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump ►. oc. I Toilet Backflow Preventer(Inside Bldg) _ <br /> Forced Air Systems 3 Unit Heater wail I Bathtub Urinal <br /> Gas Piping Boiler I Lavatory(Wash Basin) Drinking Fountain <br /> I Water Heater Refrigeration I Shower Floor Drain <br /> Gas Fireplace Wood Stove I Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting I Dishwasher Roof Drains <br /> I Clothes Dryer Hookups Other: I Clothes Washer Medical Gas 1 <br /> I Range Hood I Water Heater Other: <br /> ;L 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# <br /> ,\--!-- -)%412L___ itif 5 ( 7/D i S <br /> Owner/Authorized Ag Signature Date (Revised 10/12/2015) t <br /> ii i <br />