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PERMIT APPLICATION <br /> #1j----a <br /> BUILDINCIECHANICAL I PLUMBING I SIGN�RINKLER I DEMOLITION <br /> 40 <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: LiV--I;,, , 3CCA Li). T,,, ) ' PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 1?)Lj�;Ii1/4ji TENANT NAME (If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3c) j , C 4-51/1.-k) lR,1 , <br /> CITY E v il,6..ri STATE W,41-- ZIP ci8 ao q <br /> OWNER PHONE: LP5 ?til( OWNER EMAIL: 0do m. I,. de a tv,7 G bei.', - COM <br /> CONTRACTOR NAME 1,,)r'0,i.0 PITY /aL( ..;l� &fl L --.1:AZ. Cj <br /> CONTRACTOR ADDRESS: STREET , a G.I f "+t' 61 P. 06>i--: _ y <br /> _CITY /1 '; i 'G1 STATE v.' 1 ZIP%;9_,) <br /> CONTRACTOR PHONE:,. - 1yq- ` ( CONTRACTOR EMAIL: f 7(4v c�S�J uerc,,t�� <br /> CONTRACTOR LICENSE#(REQUIRED): :ff W1/41.7_ V %1C,, *3 '3VICITY OF EVERETT BUSINESS LICENSE#(REQUIRED)X07 <br /> PRIMARY CONTACT: ❑ OWNER . CONTRACTOR El OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: l <br /> . �'Tl 1— is,G., <br /> PA- N�� ,�374- DCS .,r� CONTACT EMAIL: h,��.1t,•1Li4(sce::i VSmc:::,i,c,.vo'J <br /> BUILDING PERMIT APPLICATION <br /> � <br /> Existing Use of Building: Contract Price of Work: $ Zi.)- <br /> / 00(J <br /> Proposed Use of Building: Heat Source: ❑Gas CI Electric CI Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel El Repair X.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> bc,L (;) io-to)_ ccGI&t1. k- i'-& t: i-t, 6fan c--r/$-9 <br /> ize P,:-4( t)(1. 5t/;k con cA -14-6 t-firk6 , OD r�r Br To acs A1444;60_ . <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 #of #of #of <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump _ Toilet I 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 I Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Chemical or Water I No. of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this app.JGatton 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 x ore beingauthorized 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 ,-the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> / City of Everett Official Use Only <br /> _ PERMIT# <br /> , = -- 6 « 7' Q ( -1f0(o - 041 <br /> •wner/Atithorized Agent Signature Dae (Revised 9/23/2016) <br />