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PERMIT APPLICATION mu <br /> BUILDIN( IHIECHANICAL/PLUMBING /SIGN /41'RINKLER/ DEMOLITION <br /> "IWOVC:g CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 l(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 2_7 3c7 1 2.Y ST' PROPERTY TAX#: Z'JO 5"1700 /03 207) <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> �.1 � CONTACT INFORMATION <br /> OWNER NAME: EV2 121 . lioOs) 606 trO 14 . TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3(O 7 a©` Vji AO"� <br /> cm, JE- 1.. Tv STATE WA- ZIP 9 B G,_S,!i <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: T <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: fl OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: J- 2_01-3 .. V ` 't` , ©74 Ly <br /> ' 74,-,...-,__031 c_t.L.1-1,)C. CONTACT EMAIL: ,f'pt,✓eky k Q. e_:‘,/ . , a . <br /> BUILDING PERMIT APPLICATION •,J <br /> Existing Use of Building: 14-4)((i-,--4-M 4...,-i 'FT Contract Price of Work:$ -r.90 <br /> JU- - t q IA o <br /> Proposed Use of Building: Sfl-r►i€ �Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex QMulti-Family-#of Units: q El Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. DSign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> %ill; ,._...! „ _ �,,,-- � � a <br /> ASSOCIATED BUILDING PERMIT#(if applicable): L.T:4-4ei-:o 4-- E1C4-e-1-%6 .e- Ye (3 ‘..N1- 1`JO dki <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New— Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> 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 /> 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ` <br /> �-6-61.11\..., �� I ''i- PERMIT ® Y _ <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) �G/'-+ '"", <br />