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PERMIT APPLICIATIO <br /> ^iv <br /> BUILDING1 MECHANICAL I PLUMBING ! SIGN I SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> *40' ' <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: in <br /> I <br /> u 1L�.,p 4 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: /t \ f4Ac �eD9 IAA t '��LY TENANT NAME(If 11 Commercial): <br /> I '� C <br /> OWNER MAILING ADDRESS: STREET 9 I x. � J� 1 n <br /> CI ���1 '.Y STATE \ A 1'�-�e..- ZIP �7_1)i <br /> OWNER PHONE:(-(Z 5 -3 7 y -30 S--3---. OWNER EMAIL: — (I 00 , c <br /> CONTRACTOR NAME: \ 4j t j)At 'P.-CC)- A t 1 rl(.-- <br /> CONTRACTOR ADDRESS: STREET CI ak l $3 �M � <br /> Q , l <br /> crryEA, O 14 S STATE I /\ ZIP C� .r.,,► rv 2k! <br /> CONTRACTOR PHONE: 9. -i 3 1-1-dR'OCo CONTRACTOR EMAIL: // <br /> CONTRACTOR LICENSE#(REQUIRED):\b \G`mozi CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):(L./, (yUd <br /> w w...._ ... V II{{�r`` <br /> PRIMARY CONTACT: A AOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CO TACT NAME:1 CONTACT PHONE: 2� —31 — Li , <br /> VA; CONTACT EMAIL: (--k-C Ac 00.0 r-, <br /> BUILDING. PERMIT APPLICATION ' <br /> Existing Use of Building: Contract Price of Work:$ ?Z-1O- <br /> Proposed Use of Building: Heat Source: ❑Gas El Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair DTI. ❑Sign ❑Sprinkler CI Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: p _ <br /> Al u (I <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> ::MECHANICAL PERMIT APPLICATION: ; <br /> PLU,MBIN.G PERMIT APPLICATION;` <br /> Type of Project: New _ Addn _Alteration Repair Type of Project: _New _Addn _Alteration Repair <br /> #of #of #of List of Fixtures #of List of Fixtures <br /> Fixtures List of Fixtures List of Fixtures <br /> 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 /> SPRLNKLER;/:;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 be"-• - thorized u •- -ny circumstance.lam the owner,or lam authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the :ate Co tr. . 7.27 RCW and 296.2004 WAC. <br /> City of Everett Official Use Only <br /> �// ` . Z— I <br /> ( PERMIT#.---17\,i <br /> _ LY Q v' O-) (l_ <br /> '�:.. Date ' (Revised 10/12/2015) ���(//� <br /> Owner/Author) • �;:,• Signature <br />