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PERMIT APPLICATION <br /> BUILDING t =HANICAL I PLUMBING / SIGN / KLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 96201 <br /> (P)425-257-8810 I FAX 425-257-6857 1(E)everetteps o3everettwa,gov wmvreverettwa,goviperrrsita <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT'SITE ADDRESS: <br /> "LAI I Sr PROPERTY TAX#: <br /> LEGAL for new construct€on: Short Piat/s.,t5divi loft tot No, (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: to RksOZ, TENANT NAME If Corntmerclal): <br /> OWNER MAILING ADDRESS: STREET j 1141,0 2.CAi.t "• `- � <br /> v �. }iii ZIP �Q <br /> CITY �4X ce STATE <br /> OWNER PHONE:_ S4°°2- 2C)9, 15 %4 OWNER EMAIL <br /> CONTRACTOR NAME ". <br /> CONTRACTOR ADDRESS; STREET <br /> CITY STATE ZIP � ��1 j <br /> CONTRACTOR PHONE: f RS' CONTRACTOR EMAIL: < . l <br /> CONTRACTOR LICENSE#(REQUIRED): t • re:-.-'7"' c{fel tire OF EVERETT BUSINESS LICENSE#(REQUIRED) " <br /> PRIMARY CONTACT: 0 OWNER w'° ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME, <br /> CONTACT PHONE, , <br /> CONTACT EMAIL:r <br /> BUILDING PERMIT ki PLICA `i ON <br /> „ isting Use of Butldinct Contract Price of Work:$ t" ..0 C)d <br /> rot, osed'Use of illdiri '_ Heat Source. <br /> tilElectcic ❑Other ._ <br /> iLlitain. T.rae: »SFR-Detached ❑SFR-Attached ❑Ou lett ❑Multi-Famil :of Units DCommerciai ❑industrial <br /> type of Pro ect. ❑New 'Witten ❑Remodel 0Rep lr OT19, D lgrt OS,rtri ter ❑Demolition DChan* of Use <br /> )ESCRIPTION OF WORK: ..:...:. . <br /> —In 5-bait 6-11s t A 54 , G r COI L,I v15 L Bets CAsez-r, <br /> iztArtQ pr plc). <br /> 1.SSOCIATIvD BUILDING PERMIT a <br /> pptttble} <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> ype of Project _New Y.. Addn Alteration `Repair Type of Project: _New Addn _Alteration _Repair <br /> of <br /> List of Fixtures #of #of #of <br /> °fixtures Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures <br /> 1 NC—Air Handling Units`' Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> I Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping <br /> Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater 'Refrigeration Shower Floor Drain,. <br /> 1" 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 /> Sri!'Ri l t SN RE$BION ye, <br /> ° M <br /> [Minter 0Had <br /> :KNOWLEDGEMENT: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 /> 'trent 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 /> Biding Official before being authorized under any circumstance,I am the owner or!am authorized by the owner of this property to perform the work for which application is made, <br /> id t comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT <br /> =ff,AUthOrI edl Agent Signature Date <br /> (Revise 9/2312016) <br />