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PERMIT APPLICATION <br /> 000 <br /> BUILDING fleCHANICAL I PLUMBING I SIGN / ®NKLER/ 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 /> II I PROJECT SITE INFORMATION <br /> OJECT SITE ADDRESS:Nog <br /> q$ e, PL s� PROPERTY TAX#: © ? /D p <br /> 44gO00©/zcc <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �T,q,2,y WAer-A,1e,2 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /9Q9 9 fdk/L5 &) <br /> CITY evir_e'rr- STATE EX)74- ZIP q?-2.047- <br /> OWNER <br /> ?-2../OWNER PHONE: 7(z -�A7 7'- 0 6, OWNER EMAIL: <br /> Pkv d-i✓/7T Pixim mg <br /> CONTRACTOR NAME: 14e,,,..]Gy <br /> CONTRACTOR ADDRESS: STREET /4,fPli /3762Ave- (.....1.3 • <br /> CITY I Vio iou)o©D STATE kjaf ZIIgo3 7 <br /> CONTRACTOR PHONE: L2-5--7'j—&el 1,4 CONTRACTOR EMAIL: & 44A)@ 'ArJ17A)/1 6.. le <br /> CONTRACTOR LICENSE#(REQUIRED):DA- 04' -gL`L/�O CITY OF EVERETT BUSINESS LICENSE#(REQUIRED.oqi <br /> PRIMARY CONTACT: 0 OWNER sgfCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT ,a-NAME:, /,�A.D� ? <br /> CONTACT PHONE: 4 fir-775./ 491 <br /> B , Aviv U\ <br /> ( CONTACT EMAIL: lJ reidAyQ gDY Al\W/Off-6 it.) ---- <br /> BUILDING <br /> ----BUILDING PERMIT APPLICATION <br /> 14ing Use of Building: Contract Price of Work:$ 'J 1- CC/ <br /> I'—osed Use of Building: Heat Source: ❑Gas Electric ❑Other <br /> Building Type: ❑SFR-Detached O&M-Attached ❑Duplex ❑Multi-Family-#of Units: 0 Commercial 0 Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.l. ❑Sign OSprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: GACe <br /> (Cl5T7rJ6- EL-C-e-T1Z?e-- f .4C6 GU ")-eu7 <br /> EL-Ee-T)Z(c- ,t,z- 9-CC S,i 5,4, te...._ Lee 111dv� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New _ Addn ,kAlteration _Repair Type of Project: _New Addn _Alteration Repair <br /> #of List of Fixtures #°f List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> I 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 /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads <br /> ''_JOWLEDGEMENT: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 /> I 144n 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Q City of Everett Official Use Only <br /> / �/ z U I(Q I7 PER I,n-es .—02 <br /> q-- <br /> Owner/Auth ized Agent Signature I ate (Revised 10/12/2015) <br />