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PERMIT APPLICATION <br /> _ /11/1111?—, ._ BUILDING/MECHANICAL/_PLUMBING/-SIGN/SPRINKLERJ-DEMOLITION -- <br /> CITY OF EVERETT PERMIT SERVICES <br /> W.' 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 j(E)everetteps@everettwa.gov I www.everettwa.govipermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION. <br /> i t X41 <br /> PROJECT SITE ADDRESS: t O�0 t A7 DA 5 PROPERTY TAX#: d 0 74,1 3 6O6 d 08O O <br /> LEGAL for new construction: Short Plat/subdivision _Lot No. (attach copy of long legal INFORMATIONdescription) <br /> � /� r CONTACT INFORMATION <br /> • <br /> �qL <br /> OWNER NAME: I j Re, r`1 1 CJ\(2.ed.-S o TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREETI 0 O % ,711' S <br /> y' I1 <br /> CITY Com• e�`t.. STATE LA-1 0 ZIP l 1S�/rSn <br /> Q <br /> OWNER PHONE: aSn' 734 " 1 37 OWNER EMAIL: <br /> CONTRACTOR NAME: R; r On. in t!A+{Ai '"l.. stele& Meted r Inc. <br /> CONTRACTOR ADDRESS: U STREET P p 1 S g Aca13 1315P A y e_ <br /> CITY 1(,a.k a 5 fe v e ri s STATE id A- ZIP g'?S'' <br /> CONTRACTOR PHONE: 4a 5_.535* 7 CONTRACTOR EMAIL: r ht b Yt e vt i'Yt @ f> 1 ef(;C d Imo( <br /> CONTRACTOR LICENSE#(REQUIRED): A (Gil-T H AA qge C/� CITY OF EVERETT BUSINESS LICENSE#(REQJIRED o g c rp q 4 <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: nCONTACT PHONE: ' l4 15�- 75 - g i J�'i <br /> f ��.S- d CONTACT EMAIL: r t tto lit i' .l i @ d Ust i I/ e.0 r <br /> 1 <br /> BUILDING PERMIT.APPLICATION <br /> Existing Use of Building: Contract Price of Work: 69 el, <br /> Proposed Use of Building: Heat Source: ❑Gas CI Electric ❑Other <br /> Building Type: El SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler CI Demolition ' ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> exf-P Nt a p r Pr r'1 Jj t0( ) © 1d I <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 Fixtures List of Fixtures Fixtures <br /> List of Fixtures <br /> Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Alr Systems Unit Heater Bathtub Urinal <br /> a 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/BarfMopletc. Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I 'No.of Heads <br /> ACKNOWLEDGEMENT:1 have reviewed this application and confirm the information contained herein is true end correct.Work done pursuant to this permit must comply with <br /> current federal,state,and local lam 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.1 am the owner,or I am authorized by the owner of this properly to perform the work for which application Is made, <br /> and!comply with the State Contractors Law 18.27 RCW and 298.200A WAC, <br /> City of Everett Official Use <br /> Only <br /> ( <br /> y6,4ap.4.49 3'_/- /7 PEi u11,T�#� 0 <br /> 3 " �J10 <br /> Owns uthorized Agent Signature Date (Revised 9/23/2016) <br />