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PERMIT APPLICATIO� mIIl1I <br /> ill:104111BUILDIN�IIECHANICAL/ PLUMBING /SIGNT�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 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only,Please) PROJECT.SITE INFORMATION <br /> PROJECT SITE ADDRESS: PROPERTY TAX#: <br /> �2.c� Q.u- ti, �cv-e, (1,66'aa6 2a 00 t n \ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (NL 6C �\\Qm, \\k\( (ow\ TENANT NAME(If Commercial): (', <br /> OWNER MAILING ADDRESS: STREET siq0 €\Jt- `�e..e.0 Wf�o4 <br /> CITY fmz.tQ kV STATE\NA zip `''g0.0$ <br /> OWNER PHONE: 1-06 - g� - )�o OWNER EMAIL: Y v <br /> CONTRACTOR NAME: :c\t\Q.. CQ\ \V`Wail\‘(.11j <br /> CONTRACTOR ADDRESS: STREET aP3 S6\1)0A, `,Q,w\i S\' SUuIkt aOb <br /> CITY l\KOIAie.. STATE IA' ZIP 6 <br /> CONTRACTOR PHONE: t V)—t-VQ- -uk-kf CONTRACTOR EMAIL: IL-Qae ame ca��methaniau ;1�,f.(,drn+ <br /> CONTRACTOR LICENSE#(REQUIRED): C'L '\' .(DI\'tiv CITY OF EVERETT BU (NESS LICENSE#(REQUIRED): % t, <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:Q CONTACT PHONE: � k -t-ku.k - h <br /> MCAAL- vCV�A� CONTACT EMAIL: %.�F , (► 01/4 (Aatne-aka ;co call,uxn <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: C\ Q, IA& i ' / Contract Price of Work: $ <br /> `IQs <br /> Proposed Use of Building: N,' , (jU (L (\((' Heat Source: ❑Gas !; lectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: <br /> Commerc'. ❑Industrial <br /> Type of Project: ❑New ❑Addition ?model ❑Repair ❑T.1. ❑Sign ❑Sprinkler ❑De '.. "Change of Use <br /> DESCRIPTION OF WORK: <br /> -2 .i.- V•St (•I G- (`(\Q&k COU (J-+0 G 6c4\Ce- S' 0S-C• `'(AavM tomov at of <br /> ' i_ C& p\u c C (\ )(%i tali �dn �w,,firrwv� I \�1.f tQ •� ,,v� Fi,/X�.,J�u,g_t�..5 (1)0 r <br /> ASSOCIATED BUILDING PERM#(if applicable): `�'���'v`''6" 1 �\eL M t tXOm `�J.NY\4• <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 /> NC—Air Handling Units Heat Pump —C Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub ‘ Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) a Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove (9. Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting % Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood _A Water Heater y Other: E)te Nj(AV\ <br /> Exhaust Fan IAA- Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I No.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 /> PERMI # <br /> • la� ia01 1g0q r4f 3 <br /> Ow er/Authorized g Sig ature Date (Revised 9/23/2016) <br />