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PERMIT APPLICATION <br /> = BUILDII— MECHANICAL/ PLUMBING/SIG SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERA <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 /> (Hlue or Black Ink.Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 13 5O 'U I AC L C glv4,! v�.ice..�r D 3 <br /> PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: W plo e-,-.1 G, 1{e. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET S'S 0 d l>e :c. Q(v-.e. 1 <br /> CITY ?ve.,,,--ri— STATE G(/ - ZIP 94-2,O <br /> OWNER PHONE: 3 (o-- 9-10,- /Ss-S. OWNER EMAIL: bdt.(ec;z11 rtts✓1.c.ottA <br /> CONTRACTOR NAME: 5'a <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: AOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMITAPPLICATION - <br /> Existing Use of Building: Contract Price of Work:$ I2,o+o <br /> Proposed Use of Building: Heat Source: ❑Gas giElectric CI Other <br /> Building Type: RISFR-Detached ❑SFR-Attached Cl Duplex ❑Multi-Family#of Units: CI Commercial ❑Industrial <br /> Type of Project KNew ❑Addition ❑Remodel CI Repair CIT.!. CI Sign ❑Sprinkler CI Demolition CI Change of Use <br /> DESCRIPTION OF WORK: <br /> ri-t s4.0.i t kat- -r,A. Cal ri aclo pee.A - t 41..1oa v% S i-oa ti c w <br /> s- 4)or ,St.�!-1,.41.c. -C-�.a' rte,. Q.cs-a✓f-t e..,n9t-. <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 /> 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 /> SPRINKLER/SUPPRESSION: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.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 /> 7//36 / s. PERMIT (s01- 011 <br /> Owner/A thorized Agent Signature Date (Revised 5/20/2016) <br />