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PERMIT APPLICATION <br /> '11P00 -7a <br /> BUILDING / MECHANICAL I PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> veil/WIZ • <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 /> PROJECT SITE ADDRESS: PROPERTY TAX#: <br /> la zoo /97h Avg 5.li . ✓rs -dT) lc./{ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> / CONTACT INFORMATION <br /> OWNER NAME: 6-1:75 )---e-c., V /iG1 C'S,4-Lt- TENANT NAME(If Commercial): i�,0 <br /> OWNER MAILING ADDRESS: STREET 6;')SS 2...,1144 Ojy,uc5 /� <br /> CITY _2460.Q(,A+y STATE [�/f', ZIP SBD Z <br /> OWNER PHONE: 1 25- 313 - I' 72 OWNER EMAIL: jf ht)L,eI �r,� <br /> CONTRACTOR NAME: / 5'7 , 5"7477 �oqq/.957�t/„z...r), 3 �JZ,vf7 j J- <br /> CONTRACTOR ADDRESS: STREET ?7 �7 <br /> CITY P y� 1-j��1 �� STATE 1�y4 zip 'AJ a/ 2, <br /> CONTRACTOR PHONE: 2�3 - 9-35-//©g if-, CONTRACTOR EMAIL:/}/2127/ eJNIt/z579j y7-7;--,7-,„p `. <br /> j— <br /> CONTRACTOR LICENSE#(REQUIRED):l A Z.c 97 g R._ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): c'5/ <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: Z>z u , <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ 24',& E <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric DOther <br /> Building Type: ❑SFR-Detached DSFR-Attached ❑Duplex ❑Multi-Family-#of Units: 121Commercial Dlndustrial <br /> Type of Project: ❑New DAddition Remodel DRepair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: _ <br /> e. /SLG=✓}/� �c>as T�"GT- <br /> O �Ti�tiSi4 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): , S"/'— <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 #°f 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 /> / ,Tvi - <br /> SPRINKLER I 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 te S-te Co actors La 27 RCW and 2 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> I <br /> Owner/Authorized' gent Signature Date (Revised 10/12/2015) r <br /> '�( ' (.1C� 112_ <br />