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PERMiT APPLICATIO <br /> BUILDIf�I� 1 MECHANICAL/ PLUMBING /SIGN I S�RINKLER / DEMOLIT'ION , <br /> CITY OF EVERETT PERMIT SERVICES � <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8510 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 4,2.1 S�A�U tZ51 av�.. PROPERTY TAX#: Zo'��, ��a 0 . �j I Z �O <br /> LEGAL for new construction: ShoR P�aUsubdivision 5� �202.—�707•D�(16bt No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �}���j ST�� ONNSD�1 TENANT NAME(If Commercial): � <br /> OWNER MAILING ADDRESS: srReer L�'12 S�A�-I�UR, �.��— <br /> CITY �V EIzETT STATE ��} ZIP `g�{/ '3 <br /> OWNER PHONE:L{ZGj'Z�D' �j�jZZ OWNER EMAIL: S�A-G{ 'p v�y�y OV�. �t/ D� a7 IML(,{,l LOVw� <br /> CONTRACTOR NAME: �w � ��,'? <br /> CONTF2ACTOR ADDRESS: sTREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CIN OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: Cr]'OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L,�r•��t�•�'Z� <br /> �C R���1� �e���5 b 1� CONTACT EMAIL: I��..P�b i°; �'�j�' y�� �/1,0 i�j�{,6 ' C d�°Le,�, <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Buiiding: Contract Price of Work:$ ` 6 � � •/ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other � �0�E <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commerciai ❑Industrial <br /> Type of Proect: la'New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Si n ❑Sprinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: <br /> �.tew 5F �����• DET�cH�v• `((�S s�.�T <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 /> #of Lisf of Fixtures #�� List of Fixtures #of Lisf of Fixtures #of List of Fixtures <br /> Fixtures Fix2ures 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 /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Number of Heads 2 <br /> ACKNOWLEDGEMENT:I have reviewed this applicatron and confirm the information contained herein is true and correcf. Work done pursuant to this permit must comply with <br /> current federal,state.and loca/law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first 6e authorized in writing from the <br /> Building Official before being authorized under any circumstance.!am the owner,or I am authorized by the owner of this property to perform the work for which application rs 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 /> PERMIT� <br /> 'v� �. , I' ZZ� � � 0� ' � <br /> Owner/ uthorized Agent Signature Date (Revised 10/12/2015) � <br /> ;\ ` � <br />