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PERMIT APPLICAT■ <br /> BUILEgrr / MECHANICAL/ PLUMBING / SIG 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 /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:, �t�t 1, PROPERTY TAX#: <br /> (' ._� f�\'i ll.jd. - �V. <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: j Lt`A 1 eL, \/,1\01 Lit,A(L TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET f5 3; c=(1-4- ` v (V\ <br /> CITY ` vex e- t.1."i STATE \J\i A"1 ZIP '?J✓ J <br /> OWNER PHONE: C(�__51 - }-3' "'C (..G c� OWNER EMAIL: '1r\ co `- I it.--(' 0- <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET .9-M{., ,� 'j 1 ' S V'( ) cc 1 e.., jy <br /> CITY M.(J V�.1�.4 a-LC. I ,l�-E' i/(f CC_ i 4'\t A ca-tA E, \AJf <br /> I3r ZIP q S�`!L.-j <br /> CONTRACTOR PHONE: (1--f- \9-1-1 -Th( < CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): j(?_1,-00 i- 4%�.i> CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ('32-1-C-i C <br /> PRIMARY CONTACT: 0 OWNER a/CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ( -'`S) 7 -( --i--1 Scl <br /> 1\4a__(t k\V'1 ��4'i11-q CONTACT EMAIL: 11,'l iZ. E j'..--AV flGLLryksLLow_frEsyF_ 0-0,---1 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ CI 6()U <br /> DU <br /> Proposed Use of Building: Heat Source: (7Gas ❑Electric ❑Other <br /> Building Type: 'FR-Detached ❑SFR-Attached 0 Duplex DMulti-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New DAddition DRemodel DRepair DT.I. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> L1 0, cti.�c-, vfit v��:& ,.Y l/,,CLv. �-'c' iL.V� <br /> - 0--,,% <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 /> Fixtures List of Fixtures Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer (Inside Bldg) <br /> I 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 beforebeing authorized under any circumstance. I am the owner,or lam authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with thp'�State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> / , PERMIT# <br /> A__ )./0-0 M n 0 ( -- 0)____ <br /> Owner/Afthorized Agent Signatur %I Date (Revised 10/12/2015) <br />