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PERMIT APPLIC <br /> grr BUILDIN MECHANICAL / PLUMBING / SIGATIONO <br /> PRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits • <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION (,g(iwow-jj <br /> PROJECT SITE ADDRESS:2 / / s h 1.4_, PROPERTY TAX#:2106 n o©�O I'600 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: g, ii,GC., TENANT NAME(If Commercial): EVC_, <br /> OWNER MAILING ADDRESS: STREET 21900 7'pw,gi 5r- Er <br /> // CITY E V 1t7 STATE L. 4 ZIP co 2.41OWNER PHONE: ..12C. 325$ Jg $ f A OWNER EMAIL:71‘,...41S ea GJ e,,VQ�•"t-Ce - p iCi <br /> a <br /> CONTRACTOR NAME: �0 rd i & Cons tithom I Irl c • <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: Vie (OD ` Up 4 21 I b <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) A4-//rcr— <br /> CONTrA�CT NAME: e CONTACT PHONE: 204 cj j i/ 11____ /� <br /> J elzr� 05-86 jZ,ti CONTACT EMAIL:�1os rn CJ,QS I1 a /.it rieriJ IA�..UV). <br /> / BUILDING PERMIT APPLICATION <br /> Existing Use of Building: GL./I Sy/20*atYYS Contract Price of Work:$ 20 060 <br /> Proposed Use of Building: C.(-4-4s/1.060\5 Heat Source: ❑Gas ❑Electric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel DRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> FSE 5-, , P tB1Ef ''tzPir('D- <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 <br /> List of Fixtures #of List of Fixtures #of List of Fixtures List of Fixtures <br /> Fixtures Fixtures 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 <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 /> City of Everett Official Use Only <br /> p PERMIT#OAAN— <br /> �i teOCCQ) <br /> Own: <br /> Drize Agent Signature Date (Revised 5/20/2016) 12_ <br />