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PERMIT APPLICATIO ", <br /> ~ BUILDINd I-IIIIECHANICAL/ PLUMBING /SIG RINKLER/ DEMOLITION <br /> 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 /> (Blue or Black Ink Only Please) /, /PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ' 3 -1(N ftt. 5& PROPERTY TAX#: O'L/6 210.0i:'11NO3?.A t= <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: L. ' /MC 1...-6.NA TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET $$03 Lpj'N PL 56_, 4G ('� <br /> CITY �j�j/ � STATE �A ZIP lig 2-4=)a <br /> OWNER PHONE: Y2'S-353- ZS73 OWNER EMAIL: <br /> CONTRACTOR NAME: SLjNJtA/116 lGnIII� 56 2).//Clc.f / <br /> CONTRACTOR ADDRESS: STREET ,-7 7_14 11 i-" 1 SSt,✓ <br /> CITY 86-r1�GLt- STATE W A ZIP -1 r 2 <br /> CONTRACTOR PHONE: —1 2-5-LIP—1!oli40 CONTRACTOR EMAIL: 51.6.46"faLG4i-..1/(,`y/ .. . N.edit." <br /> LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(✓✓REQUIRED 3-2- 52- <br /> PRIMARY <br /> 252PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: �1Ai UiS CONTACT PHONE: b _ SSS_--3113 <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION ''-, <br /> Existing Use of Building: Contract Price of Work: $ (p( '.a'. <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: El New ❑Addition El Remodel ❑Repair ❑T.I. ❑Sign OSprinkler ❑Demolition El Change of Use <br /> DESCRIPTION OF WORK: ACI -^ U,j - <br /> ASSOCIATED <br /> 14 <br /> BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn XAlteration _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 Fi' es 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 /> 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 property to perform the work for which application is made, <br /> and I comply with the State C,-tractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> / PhMIT# <br /> q—ri—n ' t <br /> Owner/Authorized s •na i re Date (Revised 9/23/2016)log -- O3 <br />