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g7TPERMIT APPLICATION <br /> BUILDING J IIkCHANICAL/PLUMBING I SIGN/UHINKLER/ DEMOLITION <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 Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ;1,0 O P iQ t►'l) ST, L krEgor Imo" PROPERTY TAX#: Od SOO 6 O o CC OC) <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: -Rh(0-155 TIN ME TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET .2_0O.2 j7/1(4.(yV <br /> CITY F VaZ.t/ STATE I ZIP <br /> OWNER PHONE: -J)..5 ?1 J- oL I OWNER EMAIL: <br /> CONTRACTOR NAME: i FLIL.C9 CTIf 11/1.t‘ 1,411-1A& <br /> CONTRACTOR ADDRESS: STREET , Li(Cf ' ' /koiE i jiE <br /> CITE L Ai 6.11)i J STATE LJ V'T" ZIP 7$ Xa_: <br /> CONTRACTOR PHONE: If°L5 - Jam'''7 CONTRACTOR EMAIL: p e±e f l' -+k 1;114L- I (0.511(0 Gil <br /> CONTRACTOR LICENSE#(REQUIRED):�r 4 fit-}C (j INS' CITY OF EVERETT BUSINESS LICENSE#(REQUI- 'D 1 Nom,._6, j <br /> PRIMARY CONTACT: D OWNER t9'CONTRACTOR 0 OTHER(Please Specify) R ' <br /> CONTACT NAME: `j3- -,. +k't G wv CONTACT PHONE: t ls'-L l r�7 z3 <br /> CONTACT EMAIL: -f 6) W15 Vt-) H,•••- <br /> BUILDING PERMIT APPLICATIO - <br /> Existing Use of Building: Contract Price of W rk:$ iSktO®,QC, <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: CDSFR-Detached ( SFR-Attached ODuplex ©Multi-Family-#of Units: --_,- "' -= - cial Dlndustriai <br /> Type of Project: ONew DAddition DRemodel DRepair OT.I. OSigri COSprinkler ODemolition OChange of Use <br /> DESCRIPTION OF WORK: -- Aja n Fp EL57-1,iti , tie �� �Ql1 v- l/IL)C. <br /> RE-t3(4-(ti� ' C6 Dri <5Pi Faci7'P21 n.37- <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 R:•:it <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of - of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC-Air Handling Units Heat mp Toilet Ba. 'ow Preventer(Inside Bldg) <br /> Forced Air Systems it Heater Bathtub - inal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposa Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Ho. ' ps Other: Clothes Washe Medical Gas <br /> Range Hood Water Hea Other: <br /> Exhaust Fa' ' Sink(5---ice/Bar/Mop/etc.) Other: <br /> SPRI, LER/SUPPRESSION SYSTEM <br /> emical or Water I fNo.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information e6nfained 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.lam the owner,or I am authorized by the owner of this property to perform the work for which applicationmade, <br /> and mply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> r 6 Z X15( PERM(Tylj \ cc, co <br /> LJ� <br /> er/Authorized t= gnatu Date (Revised 99/23/2016) <br />