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PERMIT APPLICATION <br />Mg-, MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 j FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />t pp N dJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: !�/(a &6Cots' 13fAf <br />`6 IT& 2Dt <br />PROPERTY TAX#: <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: 67rtof �uv-6' TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET 120D,< Crt2 <br />CITY,(�!�'„j' -. STATE ZIP 4`2-C> <br />OWNER PHONE: q2-S-- 25'7 -3 ( <br />OWNER EMAIL: <br />CONTRACTOR NAME: TG C3 <br />CONTRACTOR ADDRESS: STREET <br />CITY STATE ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED); <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: 5KOWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: arzLndo,1 Ljilu <br />CONTACT PHONE: q-25' 3£8-4(0i: <br />CONTACT EMAIL: " <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: ET42nfy (aaa(i""nobtW >Ydrecm <br />Contract Price of Work: $ 8 70Q O <br />Proposed Use of Building: &)W re4natr7 nee, S4rrLe-th <br />Heat Source: ❑Gas WElectric ❑Other <br />Buildin T pe: ❑SFR-Detached ❑SFR-Attached []Multi -Family-# of Units: ❑Commercial ❑Industrial <br />—[]Duplex <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair [IT.]. ❑Sin ❑Sprinkler ❑Demolition ❑Chan a of <br />UUsse( jet; Inoue <br />DESCRIPTION OF WORK: lneu,p,� kmrer"�°zr'${ f4 .�ri syn �s <br />( Ccir[tYt[ aYi ttJ��r,� �A„�Glc�t1� � J <br />&IS- i 3 f-h SF�) � 1g-n re. et tt��� . rem r n o � i�rt0ka .+art. �ur U,1 c4 It nu�u�tc1�Ud <br />S frLLa�- _`# ttx[j eieietny r . 47�}H <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: New Addn Alteration Repair <br />Type of Project: _New _Addn _Alteration _Repair <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br />A/C - Air Handling Units <br />Heat Pump <br />Toilet <br />Backflow Preventer Inside Bldg) <br />Forced Air Systems <br />Unit Heater <br />Bathtub <br />Urinal <br />Gas Piping <br />Boiler <br />Lavatory Wash Basin <br />Drinking Fountain <br />Water Heater <br />Refrigeration <br />Shower <br />Floor Drain <br />Gas Fireplace <br />Wood Stove <br />I Kitchen Sink & Disposal <br />Grease Trap <br />Gas Range <br />Ducting <br />Dishwasher <br />Roof Drains <br />Clothes D er Hookups <br />Other: <br />Clothes Washer <br />Medical Gas <br />Ran a Hood <br />Water Heater <br />Other: <br />Exhaust Fan <br />Sink Service/Bar/Mop/etc. <br />Other: <br />SPRINKLER <br />/ SUPPRESSION <br />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 />If -Lf -t& <br />tlwnerfAuthorized Agent Signature Date <br />City of Everett Official Use Only <br />PERMIT # <br />Cl�os- <br />(Revised f011212015) <br />BIZ <br />