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PERMIT APPLICATION <br /> BUILDINi �IECHANICAL! PLUMBING / SIGN�f�� 'RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVIc;t� <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov( www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT S�T A -D�R�rSS�.�,�.,�'.r'e.'��� ;��r,tOr- ``� r�$4,i+' PROPERTY TAX#: ��,.,.s�::; ���� .�24�.�/ z;r✓ <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legai description) <br /> CONTACT INFORMATION <br /> OWNER NAME:� ���MA�fT �Ol�nt� C� ft��}�� ENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReer Q �Lt1 � �f�:� <br /> CITY /�1'�Wc�L STATE Y�/� ZIP [)'✓ <br /> I �1 <br /> OWNER PHONE: ZS� ZZ•'"1E�fv OWNER EMAIL: f1�f�2LY�Ld�S�?�-,r'���'a�i�r►�6Zon9�S,�9 �tT✓ <br /> CONTRACTOR NAME; ��,��5t. ` .�q ys�t�t ��q r;S il b�oa-'�' <br /> CONTRACTOR ADDRESS: srEzee-r ----� <br /> CITY '—� 5TATE ZIP <br /> CONTRACTOR PHONE: Sa;Ir14�P rt� otK� CONTRACTOR EMA1L: S�t�l�•ts' 4 t-�c✓r <br /> CONTRACTOR LICENSE#(REQUIRED): CG�/�j PTF'f�aZ��9 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): U� 3�- <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTAGT NAME: �t�� CONTACT PHONE: •=�-�-�✓-� ���. ��� <br /> ���'S7pl^�v (�����'�'f.�i �r���S'.� �.'��"��"� CONTAC7 EMAIL: � �+ 1 <br /> .� {�b? d. EvGlD.CI�[r�S�11 �� f3�jt4� Snal:vna��i r�-,�' <br /> BUILDING PERMIT APPLICATION <br /> Existin Use of Building: ,� pdG�Gv.� -loa� Contract Price of Work:$ � Da� G5 �yt4��� <br /> i <br /> Pro osed Use of Buiidin : S�n t -��r,. �arn� Heat Source: ❑Gas ■Electric ❑Other <br /> Buildin Type: ■SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Famii -#of Units: ❑Commercial ❑Industrial <br /> T e of Pro ect: �New ❑Addition ❑Remodel �Repair ❑T.I. ❑Si n ❑Sprinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: / / / <br /> �J'/?�[/C� !?liLt/ S/!�i9, 1 f ��u!d� � ��O'S�d�y , �hrl� �✓D CAIn r ��r� b��t <br /> �wC'l�r r.7q . -� <br /> f <br /> ASSOCIATED BUILDING PERMIT# if a licable : <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 #oi List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> — A/C-Air Handling Units / Heat Pump 2-. Toilet -- Backflow Preventer Inside Bld <br /> .-- Forced Air S stems -- Unit Heater / Bathtub - Urinal <br /> - Gas Pi in - Boiler Lavatory Wash Basin - Drinkin Fountain <br /> Water Heater - Refri eration Shower -- Floor Drain <br /> --- Gas Fireplace � Wood Stove / Kitchen Sink&Disposal - Grease Trap <br /> Gas Ran e --- Ductin / Dishwasher - Roof Drains <br /> J Clothes Dryer Hookups - Other: f Ctothes Washer -- Medical Gas <br /> `� Ran e Hood - � -- Other: <br /> Exhaust Fan - Sink Service/Bar/Mo /etc. - Other: <br /> SPRINKLER 1 SUPPRESSION SYSTEM <br /> r ,�1 Number of Heads - <br /> ACKNO LEDGEMENT:I have reviewed this applicatron 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 permi[only authorizes approved work and no deviatrons therefrom.Deviations must�rst be authorized in writing from the <br /> Building Official befor�beingt�uthorized under any circumstattce.1 am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractor�Law 18.27 RCW and 296.200A WAC. <br /> � City of Everett Official Use Onty <br /> /� � _ ,' PERMIT# /�. )( ,.�I'�� <br /> , , �; � �' ���p l�I(!l <br /> - - � I <br /> Owner/Authorized Ageit!$i_ghature Date (Revised 10/1?J2015) ` � <br />