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lc?-L'' eu-fry ce,i <br /> PERMIT APPLICATI <br /> BUILD MECHANICAL/ PLUMBING/SIG RINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> `i� 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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> ;;;;CT.,-- `E ADDRESS: Ytt?/{�� <br /> PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision. v � Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 60/(K" C£ I TENANT NAME(If Commercial): 44,,\ A-06-17c (i(/4,\f <br /> OWNER MAILING ADDRESS: STREET ?12ca 'P/��,�P..Pz (O f'nCb 1 - <br /> CITY eC% STATE c ZIP P.Fz.c 6 <br /> OWNER PHONE: / OWNER EMAIL: <br /> CONTRACTOR NAME: /7(e 4v'2 P/7 c..4.-1 17/-Q <br /> CONTRACTOR ADDRESS: STREET ic9 407{- 3, ? <br /> CITY Ca-{-- / STATE (AJ ZIP f,�Fz0 G <br /> CONTRACTOR PHONE: (/tI ZCS 3S'`/5 CONTRACTOR EMAIL:,/` _ '(CA,,t <br /> / ,! ie ) .4p1,_,(SLS_ <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUI D): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: /ZS -2 3 27 <br /> K- 444 ( 4 'b/ Z 44 CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ga (V .r4p, A Contract Price of Work:$ 00 <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel DRepair ❑T.l. DSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ket r c1 c ff ei (.1 / 0)/ -r,,�' i r-+C) — O 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 #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures 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 Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 7` ./ 7 PERMIT nN J 0 (1 <br /> Owner/Autho ed Agent Signature Date (Revised 9/23/2016) . <br />