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PERMIT APPLICATION <br /> BUILDING I MECHANICAL/ PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> 477 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 /> P.ROJEC.T SITE:INFORMATION <br /> PROJECT SITE ADDRESS:6i qI r>.1„Sf 1 5 ai PROPERTY TAX#: <br /> 625 LEGAL for new construction: Short Plat/subdivision Lot Na: (attach copy of long legal description) <br /> ':CONTACT INFORMAT,ION <br /> OWNER NAME: 71A,(LC) I•--7 G(L r j=��) TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET o 5 1151- <L, <br /> coy Perim i STATE ) - ZIP g CJ 9+ <br /> OWNER PHONE: �J a,5j-9 �j-3311 OWNER EMAIL: Iry gyy,Q� 'Y v, COW\__ / <br /> CONTRACTOR NAME: -iNte <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Ij <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING;PERM1T,APPLICATION u, , , <br /> Existing Use of Building: SFP. Contract Price of Work:$ I � V <br /> Proposed Use of Eliding: Heat Source: ❑Gas ❑Electric Bother <br /> Building Type: LMSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family #of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New ❑Addition 0 Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler !id'6emolition ❑Change of Use <br /> DESCRIPTION OF WORK: ,�,n <br /> mto Vel aa-1-t ()l. U c l"Q. c& int,d,Lui aJ( c�`► Wooc <br /> a,pp4,neee. ;,w, sow w c,,,� 1pc wish out iv -. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): j pr OkaL&— C c(C V( l Y <br /> r F <br /> MECHANICAL PERMIT APPLICATION.:,: PLUMBING PERMIT APPLICATION " <br /> Type of Project: _New_ Addn _Alteration _Repair Type of Project: New _Addn Alteration _Repair <br /> #of #of #of • #of 3 <br /> Fixtures Fixtures Fixtures <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures <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(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 /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> RINR= <br /> KLE %_SUPP <br /> aSPRESSION 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.lam 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 16.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Owner/Autho Te.Agent Signature Date (Revised 10/12/2015) <br />