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PERMIT APPLICATION I , <br /> BUILDINU ,a MECHANICAL / PLUMBING /SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> E7 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:-/�,� ` ' <br /> /),� PROPERTY TAX#: <br /> b �? �l f 9 "14f !N <br /> LEGAL for new construction: Short Plat/subdivision r) .i� Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: gU C. (_IZ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ,,©9 /O7 PZ. c, 7- <br /> CITY v4 .( - STATE W/ 1 ZIP 3 243 <br /> OWNER PHONE: OWNER EMAIL: to„ ,/t,/,ere ( yc4vc . Co/Yl <br /> CONTRACTOR NAME: <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: M-OWNER 0 CONTRACTOR ®OTHER(Please Specify) / - f ...--- <br /> CONTACT NAME: -Ion/ Lot..` -7 CONTACT PHONE: ' 5 ._,4'7;9 —2-3/1 <br /> LC� CONTACT EMAIL: p ily/(�, / ,w 6'ycif�g. ‘4,„,i, <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: /L..e S i :-.3%,..-771;' Contract Price of Work:$ -LiO 600, <br /> Proposed Use of Building: ! E Cr52 }rili-L - "g {i,,,t Heat Source: `gIGas ❑Electric DOther <br /> Building Type: 'SFR-Detached ❑SFR-Attached ❑Dup ex Multi-Family-it of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition jRemodel DRepair DTA. ❑Sign DSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:CA_/r �/ a7- r4 C. <br /> -j—�v �)�m 1 ' ��L,/��/ ( p K nRce) <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 r Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> / Water Heater i 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 /> f <br /> I Range Hood �N-littgreiqzie.ater----,___ _. Other: <br /> 7 Exhaust Fan I Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT t 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 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 /> ag „'=' OW <br /> agid ' • -• • PE MIT i y ou-coZ <br /> Owner •uthorized Agent Signature Date (Revised 10/12/2015) <br />