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ogw- PERMIT APPLICATION <br /> BUILDING I MECHANICAL I PLUMBING/SIGN I SPRINKLER I DEMOLITION <br /> _� CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR:STREET-EVERETT,WA 98201 <br /> (P)426-257-8810 I FAX 425-257-8857 j(E)eVen tteps@everettWa.gov I www everettwa govipermits <br /> (Blue or Black Ink.Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:„:.214,5(1 81 g Pt. 5 PROPERTY TAX#:� 'I / 445 0-07-4,0,,z, <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ' CONTACT INFORMATION <br /> OWNER NAME: (j C 0.t P Lo K TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: ma- Er 9�•r �y <br /> ,430a, g 1 5.et <br /> CITYc....^ eLe-c 1;. STATE r" ZIP <br /> OWNER PHONE H -3%6 54 3/ OWNER EMAIL': C �t� 0 f 4(tC)o ,.c ill <br /> CONTRACTOR NAMESAl . I t. < <br /> W <br /> CONTRACTOR ADDRESS: <br /> STREET i <br /> CITY Ai`r t()Act STATE ZIP 4-0 <br /> 531, <br /> CONTRACTOR <br /> PHONE: <br /> �-�' ~-�"' ' - � / /( CONTRACTOR EMAIL � eq..1 IC lr�f��' . <br /> CONTRACTOR LICENSE#(REQUIRED) e. lir CITY OF EVERETT BUSINESS.LICENSE#REQUIRED:(/(4/75 I 2.,:z.., <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME CONTACT PHONE L ?%t-, 303-? <br /> St fizet,/ # <br /> 0 - <br /> I > t CONTACT EMAIL: ' `QJ( f i /104 <br /> BUILDINGI•P.E J..APP .IOATI N .. <br /> Existing Use of Building: Contract Price of ork:$ • 5- <br /> Proposed Use of Building; Heat Source: Gas ©Electric °Other <br /> Building Type: OSFR-Detached SFR-Attached ODuplex °Multi-Family-#of J nits: ©Commercial Chndustrial <br /> Type of Project: ONew DAdditio °Remodel ©Repair IOTA. ClSign OSprinkler °Demolition OGhange of Use <br /> DESCRIPTION OF WORK: <br /> e‘CkG' kcifl --V) (0—a6. <br /> ASSOCIATED BUILDING PERMIT#(If applicable): <br /> MECHANICAL PERMIT APPLICATION "PLUMBING PERMIT APPLICATION <br /> N <br /> Type of Project: ew_ Atkin Iteration ,,.Repair Type of Project: New Addn Alteration _Repair <br /> #of List ofFixtures FixturesFixtures#of #of #of <br /> Fixtures Figures List of Fixtures ListofFixtures List of Fixtures <br /> - <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg} <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wath Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stave 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 <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other <br /> SPRINKLER t SUPPRESSION.SYSTEM <br /> Che,- =I or Water 1 INo<of Heads <br /> ACKNOWLED r EM NT.I have reviewed this application and confine the information contained herein is true and correct.Work dont pursuant to 6%0/mit/nue compiy with <br /> current fade st::r:,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 Offrci=l b:ore being 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 t the State^. :c= ;a, 8.27 RCW a„-29a200AWAC. <br /> 3 J City of Everett Official Use Only <br /> ,t, f i.--' f tf f PERIuiT# 41 t t1 O'l 00 <br /> awner/ r thorizedAge .'ignature Date <br /> (Revised 912312018) <br />