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PERMIT APPLICATIO <br /> .. -- <br /> BUILDINILECHANICAL / PLUMBING / SIGN / RINKLER / DEMOLITION <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.govtpermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION "'"" '"' <br /> PROJECT SITE ADDRESS: 5J5 L et/cc," PROPERTY TAX#: <br /> LEGAL for new construction: Short Platisubdvshon Lok No, (attach copy of long legal description) <br /> CONTACT INFORMATION ° <br /> OWNER NAME: f y " <br /> � " In 4 . <br /> TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> yc� 5 �4 ,,ss i <br /> , <br /> OWNER PHONE: /2,0(A5"n (03 OWNER EMAIL: <br /> CONTRACTOR NAME. (: 'ti1 r it all 1 <br /> CONTRACTOR ADDRESS: STREET I Ll kj Rt2 y_ f, ,,a LL, k. . <br /> C lY '1.�1, -.+,',�L, <br /> L' ,,"t,' a STATE 4,t+k ZIP C( C'I <br /> G C <br /> CONTRACTOR PHONE: 9 - 4=.q56-( t,(7CONTRACTOR EMAIL: r . ,cci-1" 1-5:ic-yZt L,Pc4-175 corn <br /> CONTRACTOR LICENSE#(REQUIRED): irl\-t .44:Le"14T 1'2""j c.t V CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): (. <br /> PRIMARY CONTACT: OWNERI <br /> ❑ R,(CONTACTOR 0 OTHER(Please Specify) <br /> CONTACT NAMESt ; _ <br /> 4 3 C,+ CONTACT PHONE: '"1� <br /> CONTACT EMAIL: Y 2 <br /> + lt G7►1, fi(lc .(on-, <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building' CJ, <br /> . Contract Price of Work:$ t _ s, <br /> Proposed Use of Building Heat Source: ❑Gas Ytlecttic ❑Other <br /> Building Type: FR-Detached DSFR-Attached ❑Duplex DMulti-Family-#of Units: ❑Commercial ID Industrial <br /> Type of Project: ❑Naw ?Addition ❑Remodel ❑Repair OT.I. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK. <br /> Zns+ A ham- pmp Sy S 4-ern <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Wt. Addn y Alteration _Repair Type of Project: New Addn Alteration _Repair <br /> #of <br /> List of Fixtures #of <br /> 4 of <br /> Fixtures Fixtures List of Fixtures List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures <br /> NC-Air Handling Units 1 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 HeaterRefrigeration 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 mater Heater Other: <br /> Exhaust Fan Sink(service/Bar/Mopletc,) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads <br /> ICKNOWLEDGEMENT: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 /> urrent 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 /> Wilding 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 /> nd I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> e ---- ilatJa <br /> ' ., ,v.„..—.er ..,, PERMIT# <br /> D62- <br /> 11v114/Authorized Agent Signature Oat (Revised 9/2.342016) <br />