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"IP PERMIT APPL,ICATIC;; . <br /> UILDAMhECHANICAL I PLUMBING I SIG INKKLER/ 1 EM0Lill®! <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 /> (Blue or Black Ink Only Please) PR JECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:Ye , Sea kUA[ >$ ' r'J PROPERTY TAX It <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:R ( I 'O1J TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 4-Rep <br /> -3-,(1, <br /> a cit,( -,* 4s, , <br /> CITY Ue i e4'A STATE - ZIP 9 g-).C2 <br /> OWNER PHONE: 430c4:3-0 27 -) ��O�WNER EMAIL: crt+a,itcS QS` "f��,�/Z.Qe r G,A4A <br /> CONTRACTOR NAME: +t"(,C 0111)4 CCd (/(.�"��i cth . .-1/( C., <br /> CONTRACTOR ADDRESS: STREET / 41)SO �¢ �(.0 y 9 Li /0 ( �/y� <br /> crfY 1_-y/V000 0 f STATE �/ ZIP" PO 3 1/1 -f-. <br /> CONTRACTOR PHONE: ONS—' -7(.1C-S' sq ?7 CONTRACTOR EMAIL: Oki c c5 ad(J 'G'ICe(/jj(s4aele fjej •p. <br /> CONTRACTOR LICENSE#(REQUIRED):61 ;' 3 d CA CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):1931-WSJ <br /> PRIMARY CONTACT: 'OWNER `❑CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: vs-F.--2q 3-7 3 c r <br /> C,ti(T�ItQ/�'"" CONTACT EMAIL: 7 s- (J d a8`cD yQtic . Corte <br /> BUILDING PERMIT APPLICATION <br /> t <br /> Existing Use of Building: C9i .(J -4\ynd Cf Contract Price of Work:$ J6d f�r00 <br /> Proposed Use of Building: Heat Source: 'C G.as DElectric ❑Other <br /> Building Type: DSFR-Detached ❑SFR-Attached DDuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ONew DAddition IARemodel El Repair ❑T.I. DSign El Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: .-- �, rr,, �� <br /> `-►2 (, `TV'C � .�V(�c a- T1 ed - j':U e p cLvt ogs' fs <br /> ig Q,6-Ve,r- re 000(0-A, <br /> ASSOCIATED BUILDING tis IPERMIIT#(ifrapplicable): � "L, 0 al/4 1 . <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 /> J. 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 /> Chemical or Water I No.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 I am authorized by the owner of this properly 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/Ussee Only <br /> •• 490-24401k v J P14/7-- PERM 4q . lJ9 2 <br /> wne/Authorized Agent Signature Date (Revised 9/23/2016) <br />