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PERMIT APPLICATIO:1 <br /> /411.;—""A' BUILDING / MECHANICAL I PLUMBING I SIGN /SPRINKLER/ 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 /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS , , A PROPERTY TAX#: ,J(:,,'/,i___('j 7 c-5"c-5" 770c...) ( ? O c-� <br /> 5 , '. ..Na rft . <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CO N TACT I N FO RMATI ON <br /> OWNER NAME: /144._-rt--- 5 w lot►V✓L 1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Z5 2.5 �/, .r- 0 c A_ ...ii, C-'e- ! [, 4 <br /> CmY E-,/L CL± '-V STATE _ 4- ZIP ` (J z C: ( <br /> OWNER PHONE: 4-(Z S-- 3(cl • I t cl." OWNER EMAIL: l,___,� c L., /u Z co NA Cc+s IA.{+ <br /> CONTRACTOR NAME: f-(-e2 irk/els,e,,,-1..e.(-- <br /> CONTRACTOR <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: i-'OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L(2 5 _ 'j t (4 ' 1 L(4-3 4 <br /> MA---r-r- S ) Li CONTACT EMAIL: (_ c t L, c c vyrc c�� (-- . ,, <br /> ,;: ; . BUILDING. PERMIT APPLICATION ; <br /> Existing Use of Building: 4SI�le-- p�TA'� Contract Price of Work:$ <br /> Proposed Use off_B,uil ing: -- Sieg. P-�74CM5 Heat Source: ❑Gas C lectric ❑Other <br /> Building Type: l BFR-Detached ❑S�FR,ttached ❑�Duplex ❑Multi-Family#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ONew OAddition L`�'Remodel Elf epair OT,l. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: nA c, 4 C L- ." t cA (---C70 Ct , % re�y'(ct<[_ /�c'1 /Oaf �(t), I-,lej <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 1(Repair <br /> #ofList of Fixtures #of List of Fixtures <br /> Fixtures <br /> List of Fixtures Fixtures List of Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Z Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater ,5,._ 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 i..... 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# <br /> // e . 3/x/71 (tit) 1(9D3" ®c <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />