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Mar 03 2017 02:35PM Washington Water " ters 8663757454 page 1 <br /> PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OL 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 i FAX 425-257-8857 j(F)evereltepsQa everettwa.gov i www.everettwa.gov/permits <br /> (glue or Black Ink Only(Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: �� Cts fl v GL PROPERTY TAX#: i(t Lj <br /> LEGAL for new construction: Short Plot/subdivision Lot No. (attach copy of long legal description) <br /> c CONTACT INFORMATION <br /> OWNER NAME: �� ,{ u- �, CQ✓ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sraeeT <br /> c, /CITY `/ ( STATE ZIP ( ,� <br /> OWNER PHONE: �C ✓`�L' � OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET gGv D <br /> rr CITY STATE ZIP <br /> CONTRACTOR PHONE: Z J�� j" L19'71 CONTRACTOR EMAIL: !/ C m1g1C" (a`'j'J <br /> CONTRACTOR LICENSE#(REQUIRED): Wn-&h9I 7kq-? d CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): o53 <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME- �1 �p CONTACT PHONE: �5�� 3 -L/9 7/ <br /> CONTACT EMAIL: <br /> BUI ING PERMIT APPLICATION <br /> Existing Use of BuilContract Price of Work:$ ' <br /> Proposed Use of Building: Heat Source: s ❑Electric ❑Other <br /> Building Type: KE'R-Detached ❑SFR-Attached ❑Duplex ❑Multi-Famil -#of Units: ❑Commercial ❑industrial <br /> T e of Project: ❑New ❑Addition ❑Remodel ❑Re air [IT.[. ❑Sign ❑Sprinkler ❑Demolition ❑Chan e of User �. <br /> DESCRIPTION,.pF WORK: <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 _Repair <br /> Fixtures List of Fixtures Fixtures Fixtures Fixtures List of Fixtures #of List of Fixtures #Of <br /> List of Fixtures <br /> AIC—Air Handling Units Heat Pump Toilet Backilow 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 Ductinq Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust an Sink(Service/Bar/Mo /etc.) Other: <br /> SPRINKLER / SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT.I have reviewed this application and confirm rho information contained herein is true and correct.Work done pursuant to this permit must compiy with <br /> current federal,slate,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviatlons must first be authorized In writing from the <br /> Sudding Official before being authorized under any circwnstanre.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 State Oontractora Law 1827 ROW a d 296.200A WAC. <br /> r City of Everett Official Use Only <br /> PERMIT <br /> # <br /> OwncllAuthorizedWge tor <br /> SignaDate (Revised 512012.016) <br />