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R <br /> IT <br /> BUILDIN ) MECHANICAL PILUMBING //SIGNI INKLER/ 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: -A735--- GGA/Pj,p/,4ft PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Dar)SieltiVeeec vi-39/JJ'j got/2e TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 4ZeFRA ! t �{'��✓� �e� <br /> CITY rC�e�--sfj"' STATE h�1V ZIP 437.0 <br /> OWNER PHONE: yz5�7d d %ZS"��3l:Z, Z OWNER EMAIL: 4+41zp yGjlpr>, '(/ <br /> `1 <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET j <br /> CITY STATE ZIP i _ _ r <br /> CONTRACTOR PHONE: Z-(Z.- 23 Z ,.O 1 CONTRACTOR EMAIL: ga(,¢2gftC®(�t 9cr log 6C��(Yr/r <br /> CONTRACTOR LICENSE#(REQUIRED): KouCi vt C i 9 ?/L.11 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ,OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> 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: DNew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> t26-Pf'ZtV Foe, d- "7-faos5 $ Feam vlhtea ps-Aerx, <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 #of List of Fixtures List of Fixtures #of List of Fixtures #°{ 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 /> 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 circum • -.I am the owner,or lam 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 -C and 29:200A WAC. <br /> City of Everett Official Use Only <br /> PERMI <br /> 13 027(0 <br /> 1/2) <br /> Owner/Authoriz-. gen . - <br /> Date (Revised 9/23/2016) <br />