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41:7PERMIT APPLICATION <br /> BUILDINECHANICAL/ PLUMBING /SIGN / INKLER/ 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 /> PROJECT SITE:INFORMATION <br /> PROJECT alTE��ADDRES: 5¢ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION: <br /> OWNER NAME: fl- 12 . TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Pct tr (S p I L.4 _ 2J,r/1 J 370c, <br /> CONTRACTOR ADDRESS: STREET //.f 3S// _ /.5 '-F---t J j,(/ 9 <br /> CITY J 1��"'-/ STATE Ly/ „,9 ZIP 9P / ' <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): ) /9/ 'f S p,.7t 1 O/L � IW <br /> . CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): /� t qit/ <br /> PRIMARY CONTACT: 0 OWNER I'-CONTRACTOR 0 OTHER(Please Specify) td► i, <br /> CONTACT NAME: CONTACT PHONE: . ,o 6 cis-5,—9..?PG/ l J- C' - <br /> c w-, (--P,._Nrsks CONTACT EMAIL: S I n. Pa i c S P/1. het✓ 3 ir1C. , liJY7) <br /> BUILDING;PERMITAPPLICATION <br /> Existing Use of Building: Contract Price of Work:$____410.1.00®� <br /> Proposed Use of Building: �i�,ii�B� � ,Ccs Heat Source: E t3as DElectric ❑Other <br /> Building Type: DSFR-Detached OSFR-Attached ❑Duplex ❑Multi-Family-#of Units: L C mmercial ❑Industrial <br /> Type of Project: ONew DAddition ORemodel ORepair DT.I. DSign DSprinkler ODemolition OChange of Use <br /> DESCRIPTION OF WORK: nd ji2 g,.,,,,-In r - <br /> blteoi'-Wo5 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 6 Al 1 f 1 h <br /> MECHANICAL PERMIT APPLICATION. PLUMBING PERMIT APPLICA- ION <br /> Type of Project: _New _ Addn _Alteration Repair Type of Project: New _Addn _Alteration _Repair <br /> #of List of Fixtures #°f List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump oL Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub - Urinal <br /> Gas Piping Boiler Z 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 I Water Heater Other: <br /> Exhaust Fan / Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER I 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> / 1-L.-.2_:2 <br /> PERMIT# nl sr) <br /> � I -0 <br /> Jh <br /> In <br /> a2'i� Y <br /> Owner/ rized Agent Signature Date (Revised 10/12/2015) <br />