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• PERMIT APPLICATION <br /> 4W7-r BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERIVIIT SERVICES <br /> 3200 CEDAR STREET.E RETT,WA 98201 <br /> (P)425-257-8810 ! FAX 42.5-2.57-8857 ;lEl tteps`ae rettwa.gov I www.everettwa.gov,permits <br /> (Blue or Black ink Only Please) PROJECT S17VINFORMATION <br /> PROJECT SITE ADDRESS: !. ( t-'vet C 1 4r)WCC / 1 (-O I A PROPERTY TAX#: <br /> LEGAL'r.r iev; .,nstruction Sort Flrr s,rhdivis'on No (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Chll t"7�)�lU (�S((,{^�� 2),(1Zi 1 L-L�_TENANT NAME(If Comirr i <br /> OWNER MAILING ADDRESS: STREET p Q <br /> r9/v R /VrNv/ <br /> OWNER PHONE: _ L4 70CI JOWNER EMAIL: / eZ t-7 5r,(14'0 C Le(' rS C L)r <br /> CONTRACTOR NAME. 1f t-. r /-Of <br /> CONTRACTOR ADDRESS: �lt ' j eS17 <br /> ::'ITY CvLift) g STATE.TAT�E/F �t �- <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: S /^v r C u <br /> _ CCE— <br /> CONTRACTOR <br /> '�— r oL <br /> CONTRACTOR LICENSE*REQUIRED C.N j CE004 K CITY OF EVERETT BUSINESS LICENSE#(REQUI D) M-0422,� <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR 'OTHER(Please Specify) MGn C <br /> CONTACT N�jAME: A f�! r� CONTACT PHONE: <br /> CONTACT EMAIL: <br /> Cd�^cp-i) (fie} BUILDING PERMIT APPLICATION <br /> Existing Use of Bwl 1uig: Contract Price of Wor : $ <br /> Proposed Use of Build;n Heat Source: []Gas-- <br /> er <br /> Building Type ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of ❑Commercial ❑Industrial <br /> Type of Pro)ect ❑New ❑ didon ❑Remodel ❑Repair <br /> T.1. ❑Sin ❑Sprinkler ❑Demolition ❑Change of s <br /> DESCRIPTION OF <br /> -WORK: <br /> cin r),- <br /> In, <br /> - <br /> ASSo? errn,k �cc `red t�h t ►nc� \.-ick J eY r `r . <br /> . <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New <br /> #of _Adds _Alteration Repair <br /> #of #of _ <br /> Fixtures List of Fixtures List o/Fixtures List of Fixtures #o/ <br /> Fixtures Fixtures Fixtures List of Fixtures <br /> A C—Air Handling Units Heat Pump Toilet <br /> Forced Air S stemsUrit Heater Bathtub Backflow Preventer Inside Bldg) <br /> Urinal <br /> efn eration Lavatory(Wash Basin <br /> Gas Piping Boiler Lt <br /> Water Heater ) DrinkingFountain <br /> R <br /> (Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Tra <br /> Gas Range Ductingp <br /> Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other; Clothes Washer <br /> Range Hood Medical Gas <br /> Water Heater Other: <br /> Exhaust Fan Sink(Service/BariMop'etc.) Other. <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Chemical or 4Caterr No of Heads <br /> ',C •NONl EDGE.,4ENT i nal-e rEvierved ttLa..ap 6caUon and cont.m,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 a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Bud 0cial befnr being authorized tinder circumstance.f 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 Wi t stfte Contractor 18.27 RCW and 296200A WAC. <br /> City of Everett Official Use Only <br /> _ PFR PR# <br /> Ownu h rized Agent Signature Date <br /> 1 <br />