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PERMIT APPLICATI <br /> BUILDINOMECHANICAL / PLUMBING / SIGPRINKLER/ 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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 2-1 2-7 IN -TVN OQ-e' Me_ v4/6Q- ' T PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision;;J 13UG gortot No. )t (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: f .' �, !�(� (�{,C TENANT NAME(If Commercial): MA-Q{Z1-1i'J j` Lo j F <br /> OWNER MAILING ADDRESS: STREET PO 130x /4(0(,() <br /> CITY 471 I STATE 1414- ZIP ,S:)49,5 Z.. <br /> OWNER PHONE: C OWNER EMAIL: <br /> CONTRACTOR NAME: (-• <br /> CONTRACTOR ADDRESS: STREET so q GN--t t4 V L(ALF' 4 U _ <L) <br /> CITY S NO fro ✓►'1 f S STATEkm <br /> • ZIP C Z C U <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): G 0 Ony i 6C -' 102 L- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):¢Z 7Z- 18 9 <br /> PRIMARY CONTACT: ❑ OWNER 0 CONTRACTOR 13 OTHER(Please Specify) r),E'rj L't 1 ELL- <br /> CONTACT <br /> LL.CONTACT NAME: CONTACT PHONE: 20 -35"J _ 3c,3 & <br /> WF_ \( P ( Qce- CONTACT EMAIL: LAJ0 5 .`�) W€S Pig E.- • cat.✓ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Opp- Cf _ F, Contract Price of Work: $ 744/ 4.9 <br /> ft <br /> Proposed Use of Building: ` c FF- a-7Y- Heat Source: ViGas DElectric DOther <br /> Building Type: DSFR-Detached IDSFR-Attach-. ❑Duplex ❑Multi-Family-#of Units: ®Commercial ❑Industrial <br /> Type of Project: ❑New DAddition DRemodel El Repair DT.I. OSign ❑Sprinkler ❑Demolition NChange of Use <br /> DESCRIPTION OF WORK: <br /> 1 MTTa21.o 2 11 4A Kid t v t°0-6 tie INL TI`LrS T(42 1 .l1rAN Gu Ff Err stiz9 f • <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 List of Fixtures #of List of Fixtures #of List of Fixtures #of 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 /> PERMIT# <br /> "tel <br /> Owner/Authorized Agent Signature Date (Revised 5/20/2016) <br />