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PERMIT APPLICATION <br /> v''-'10'e,"77. BUILDI .I MECHANICAL I PLUMBING I SIG 1-SPRINKLER.I DEMOLITION <br /> " CITY OF EVERETT PERMIT SER <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 /> Tie.or i€lac6:s-le1k.*ON P?llcaso) PROJECT SI`Z'E INFO.000 al. ..: . <br /> PROJECT SITE ADDRESS: G) _ W/( jJ.. e L ,d i,04 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> : . ' .• . - 061040'INFORMATION : - I <br /> OWNER NAME: tot Uv I ( ( o/L.L TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET -! t J w <br /> // CITY (VA <br /> `t l t/STATE RA ,/��, ZIP O l 1 <br /> OWNER PHONE: '� d,� fag A OWNER EMAIL: ( �!�! e' `"� K G�� I ``' G0 CY <br /> CONTRACTOR NAME: If <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 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAM : CONTACT PHONE: 1...11%--} 3'7.- 3? <br /> Ni/1 `� l1 <br /> CONTACT EMAIL: Q5 ( ve_,r-w p]12,t ( _ (not <br /> :BUILDING.PERMIT:APPLICATION •, <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project ❑New )]Addition El Remodel El Repair ❑T.I. ❑Sign El Sprinkler ❑Demolition El Change of Use <br /> DESCRIPTION OF WORK: <br /> �R 6k. wC-0.�L. .. c. t4 I () f w c__ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> .. . .,;. .MECHANICAL.PERMIT'APPILICATION PLUMBING PERMIT.:APPLIICATION <br /> Type of Project: New Addn Alteration Repair Type of Project: New _Addn _Alteration Repair <br /> #of list of Fixtures #°f List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—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 /> SPRINI IInER/SI PPIRESSION 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 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 /> I11 oe k(i����"-d 0 Y k { PERMIT#t . ( �0,--j� <br /> Owner/Aut I.rizedAgentSignature Das (Revised 5/20/2016) <br />