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• PERMIT APPLICATIO• <br /> #111P‘Olo%r=g BUILDING I MECHANICAL I PLUMBING / SIGN / SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE#5US: .renis 0.5to, View, cTe2.43IPROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Erin 9-- M t(;11o1CA <br /> c-PaC ,irTENANT NAME(If Commercial): ------- <br /> OWNER MAILING ADDRESS: STREET 485q \J &} t Plane T <br /> C� -err- i-- STATE W 1 ZIP t 4j1Q I <br /> CITY VVTTT.YX1'Y ttt--///VaV<V �� <br /> OWNER PHONE: 42,5.55`1.11 OWNER EMAIL: e? tDZ$821 @LJ11"" ev.60 <br /> YY) <br /> CONTRACTOR NAME: -41)111) cP\IA.n-1bir 9--R -Eer- NSLLG <br /> CONTRACTOR ADDRESS: STREET 540-4- 9 I b Ave, IV N - P ! V <br /> CITY WV/ t I STATE W 1+ ZI2 <br /> 9-0 <br /> CONTRACTOR PHONE: L 25 • 3 c3 'i' ' i 5 O-7 CONTRACTOR EMAIL: it. Cd 1)O I\D 0 UMIO ' C$ <br /> CONTRACTOR LICENSE#(REQUIRED): A'' O LL iPL 0 3 L...."1- <br /> - 1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): v 5-j 06 <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ala S• 35q - 3 gQ tQ <br /> A‘cx, SCONTACT EMAIL: a`-X @ aPO Il a PWile?IMUZ7- Cpm <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: _Contract Price of Work: $ <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION - <br /> PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn Alteration Repair Type of Project: New _Addn Alteration Repair <br /> #of #of List of Fixtures #of List of Fixtures <br /> List of Fixtures #of List of Fixtures Fixtures <br /> Fixtures Fixtures Fixtures <br /> NC–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: inr?,pe_ch yt +' <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: _)_Jj,4Q dz t.L <br /> SPRINKLER I 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 /> Bui•'•.Official before be autho 'zed 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 /> d 1 c. •ly with the ate Co itra ors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only <br /> ' 'I , v •- o(D ) <br /> O <br /> ! . � '--3-2_, L PERMIT# l <br /> 0 nor/Authorized Agent Signature Date (Revised 10/12/2015) <br />