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PE!MIT APPLICATION <br /> DUILPIN ECHANICAL/ PLUM':NG I SIGN /Sr.;y' INKLER/ DEMOLITION <br /> "pi_ <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 is lack Irak Only Please) 7 r:SJECT SITE INF 4'RM I TION <br /> PROJECT SITE ADDRESS:7a 67 vE ry) I/,fF,� �,, (_ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision JJ / Lot No. (attach copy of long legal description) <br /> m <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): 4l-e ( K`01 <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 5(3)/14y4 Ai 144 billy a yj( Bealli J C, <br /> CONTRACTOR ADDRESS: STREET 17 s-ek, 2 q A o01, S <br /> CITY 90,i'kl.1 STATE ltil ZIP q$®)a. <br /> CONTRACTOR PHONE: 2 1�7 CONTRACTOR EMAIL:` ]VOYny (/� rn fJ G dleya rr9/ CO�i <br /> CONTRACTOR LICENSE (REQUI ED):5(SLiy49 CXYa-1 f\ CITY OF EVERETT BUSINESS LICENSE#(REQ ED)573 FT(/ <br /> PRIMARY CONTACT: 0 OWNER "CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:014 ��,— W-7 <br /> 7 <br /> —SeFF .,\T (CIS CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <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: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 46 -i .()"("U&--0-__- — ‘--\ RC.2 -00 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHA11ICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project:A New _ Addn Alteration _Repair Type of Project: _New Addn _Alteration _Repair <br /> #of List of Fixtures #°f List of Fixtures #°f List of Fixtures #°f 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 /> a„ Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting ishwasher Roof Drains <br /> Clothes Dryer Hookups Other: othes Washer Medical Gas <br /> Range Hood „ Water Heater Other: <br /> Exhaust Fan `nk(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water 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 Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ( D4)-0 ) PER <br /> -c <br /> • •r orize.Agent Signature e <br /> (Revised 9/23/2016) <br />