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! 41E7T PERMIT APPLICATION <br /> BUILDING I Ic: CHANICAL / PLUMBING / SIGN / ::: I tINKLER/ 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: 1102 11fil A-vt n61t1,A, PROPERTY TAX#:2.(60 1c.004DOV,DD <br /> LEGAL for new construction: Short Plat/subdivision 1 112.0N 12.0�� Lot No. (attach copy of long legal description)66, aft U/L <br /> I CONTACT INFORMATION <br /> OWNER NAME: (/OQ�-F�(,1 0&1110e0 TENANT NAME(If Commercial): twit(' Pri 4Y5 <br /> OWNER MAILING ADDRESS: STREETT/�.Q ,DOS, 11112 <br /> 1" <br /> CITY 1 ( ' X, STATE VON, ZIP 610'q 07 <br /> OWNER PHONE: N/k-,-- �, 1 OWNER EMAIL: NA <br /> CONTRACTOR NAME: ' I. J <br /> CONTRACTOR ADDRESS: / STREET 12'4 (A )02/-4 L- Sc...- k. S <br /> `/ CITYCi: ���"' STATE Can S ZIP <br /> CONTRACTOR PHONE: - CQNTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(RE � �-( l � .._• <br /> ir a ,CITY OF EVERETT BUSINES LICENSE#(REQUI--. ,1 �• \w <br /> A,� I/ i <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR OTHER(Please Specify) 1.^er ( i-e4,r�' i)ilte ( o <br /> CONTACT NAME:LCONTACT PHONE:Q,/, • r7 .41)00 <br /> ��I``kc 041 <br /> CONTACT EMAIL:41 r[IL/tUr w44•GOM 'I- <br /> BUILDING <br /> -BUILDING PERMIT APPLICATIO)L ._..-- ---) <br /> Existing Use of Building: M Contract Price of Work: $tF) 000. <br /> Proposed Use of Building: M Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached 0 Duplex ❑Multi-Family-#of Units: ,Commercial 0 Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair gi.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ox t_ 14/1(0VOnAlt C( e W-Fv "1 Cma IT veaft/O) Units CI) office_ rel o ctl'ea v <br /> Q ,lot}11\4& 10141,14. Merzahia. vic6 hu(Itler Uhoil intiA du i WAN) rermii-• <br /> ASSOCIATEb 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 1 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 /> Chemical or Water I No. of Heads 1 <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 /> 9- <br /> n ++4 (0�7- <br /> iCity of Everett Official Use Only� <br /> 1 ` -' b . PET# O 2 c- v/ <br /> Owner/Authorized Ageht Signature Date (Revised 9/23/2016) , - <br /> ( Z) <br />