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1//0!SI <br /> PERMIT APPLICATION <br /> BUILDING ECHANICAL/ PLUMBING /SIGN'' RINKLER/ 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 InkO_nl Please PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 2,5 ( ( V . 0 ,n r u. A.A.- PROPERTY TAX#: 43-4-g S 0005-Q00 3 <br /> LEGAL for new construction: Short Plat/subdivision f ;`) T- Lot No.c-<p (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: bate b( M ,x'14(9 j 1 TENANT NAME(If Commercial): N. <br /> OWNER MAILING ADDRESS: STREET I ( V;/8;,A"(.,e.,i A <br /> CITY ••••34.,..ekitk, STATE `l.)413 ZIP 9g.f3 1 <br /> OWNER PHONE: 29 b Csr) . 5"I q L OWNER EMAIL: SL4 C .4 , tAAAJ r!!eon <br /> CONTRACTOR NAME: C0j0 '17/X)('jOry LL <br /> CONTRACTOR ADDRESS: STREET PO (;0 /� <br /> CITY 11)0') /)l�VII STATE ZIP iib .- <br /> CONTRACTOR PHONE: (?_0b (.705. <br /> t9� 5/.)/ jjCONTRACTOR EMAIL: Sej Gge1S1v'0 4 rA � �J y 1�Q f,�y,,__ <br /> 1 " 7 <br /> CONTRACTOR LICENSE#(REQUIRED). S� f^C,( A) CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) <br /> PRIMARY CONTACT: 0 OWNER 1R,CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: j� CONTACT PHONE: (to(7) L <br /> P 2,7 (..,Q , r CONTACT EMAIL: cedierpx_544,0 Ci r CfY 1/1% <br /> ;:.BUILDING-:PERMIT APPLICATION ' �� <br /> Existing Use of Building: re_,s /C @�,� _ Contract Price of Work:$ 014 <br /> Proposed Use of Building: $ pj _ Heat Source: OGas Electric 0 Other <br /> Building Type: ; FR-Detached ❑SFR-Attached ❑Duplex DMulti-Family-#of Units: 0 Commercial 0 Industrial <br /> Type of Project: ❑New DAddition DRemodel El Repair ❑T.I. ❑Sign ❑Sprinkler ODemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> acid) 2 ge_uviA S vv‘ c 1- 1709+x- <br /> OeN vVIAU1 6100/‘`) aLQ.A.0 4/05444-1 <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 /> !Number 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 /> PERMIT# <br /> 6/11 (016, <br /> Owner/Authori ed Age _Si. ature ate (Revised 5/20/2016) .�. <br />