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/11Ptie://----1-' <br /> IIPERMIT APPLICATIOBUILDING J MECHNICAL/PLUMBING /SIGNINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECTSITE INFORMATION--7.--_-- <br /> PROJECT SITE ADDRESS:A2 .eb 1 s fl l g PROPERTY TAX#: <br /> LEGAL for new construction: ShortZPlat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:`)XY\/. - ,,5 (2)61-1r .\-- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET � v L.- f!) 1 C ( c F. <br /> A G� <br /> CITY �� STATE W A ZIP 1 2 b/ <br /> OWNER PHONE:Li 2'3271 _ s 2( OWNER EMAIL: 1 v ,I, °'ems IakvteCfD 'I UV •C_(: <br /> CONTRACTOR NAME: g�tA.R_ -fir \WY‘J�-1J <br /> CONTRACTOR ADDRESS: STREET 1 ( 1 LQ 7_1 OV^ Ski.' -`� /� //��"� <br /> CITY As-AAA`c:k fL� "�'Q,I ` .�. STATE L "� ZIP I. &)`1--f 3 <br /> ti, <br /> CONTRACTOR PHONE:�� C-1 (3 ) CONTRACTORtt __ EMAIL: j v f Q 1leAA. ,,1(, C /f•GAJ''t <br /> CONTRACTOR LICENSE#(REQUIRED): � '' 1 4' V )(.P CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): o2-J g V <br /> PRIMARY CONTACT: 0 OWNER ,ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ES -77 1 ----( ( ). I <br /> V-- (Ait fAAi & k w\ t ")-- CONTACT EMAIL:kmp 6L ,e tiA Q. r /• CT <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ ,, L <br /> Proposed Use of Building: Heat Source; PGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached FR-Attached 0 Duplex ❑Multi-Family-#ofofUnits: ❑Commercial ❑Industrial <br /> Type of Project: ONew DAddition ❑Remodel 0 Repair ❑T.l. OSign ❑Sprinkler 0 Demolition Cl Change of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED 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 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 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 Fir place Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Ramie Ducting Dishwasher Roof Drains <br /> Clothes ter Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER'isUPPRESSION 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 compty 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 1 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 /> 1("6,4j t <br /> PERMIT# <br /> OA 1 U01 ID (0 <br /> Owner/Author• ed Agent Signatur:; Date (Revised 10/12/2015) <br />