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PERMIT APPLICATIO <br /> BUILDIN ECHANICAL/PLUMBING/SIGN //11111 .-A <br /> RINKLER/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 J www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 120° 06l.PJ( p'ius PROPERTY TAX#: 0040°1421C% 0 %L0n <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: G h .tj J TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET mon 1 Cl6Urf AveNu E, <br /> CITY EuGti. STATE q ZIP 182,01 <br /> OWNER PHONE: 204• °131 • 0VW OWNER EMAIL: CIAt,It4 Q AtitL bkiEVEten.(AW% <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: V OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: c-- CONTACT PHONE: Zap,1st .041°f 0 <br /> G pt` Ls 7C.it .0 * . CONTACT EMAIL: GALA" AtiC t utob jeuti'}.cam <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 5pE,,, Contract PriceofWork:$`f erteQ ` OO <br /> �'J.j) .° <br /> Proposed Use of Building: SFIe, Heat Source: ,ryGas ❑Electric ❑Other <br /> Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑industrial <br /> Type of Project: ❑New 'Addition Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ODemolition OChange of Use <br /> DESCRIPTION OF WORK: isio44 GTy LA4£/SUtre >Acscmillyo dvet. jea*.plawcut PEt .i ttfEb c ev lt.+f-VtS <br /> vzst.v_. #'i Lmo-c't' isAvewb t ; (AKA)mew.) ' 1 tMAY. AtrtASLE VACS. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 131(DO4- 051 <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 /> A/C-Air Handling Units Heat Pump 1 Toilet Backflow Preventer(Inside Bldg) <br /> 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 /> G Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> INumber 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!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# ®t9! of <br /> 5.31.2.014 <br /> Owner/ uthorized ent Signature Date (Revised 5/2016 <br />