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PERMIT APPLICATIO <br /> BUILDIAECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> 477 <br /> CITY OF EVERETT PERMIT SERVICES <br /> 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 /> pp i 5.vqPROJECT SITE INFORMATION <br /> PROJFT$TEeA?RE SS' , ) INF} 9201 PRV5(0. 1 7.3 2 4-0 <br /> (0)00 <br /> LEGALt(ffor new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ALAN (/TL i9-#04 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 7b I S S4-5 qO1-1-, SI- <br /> CITY <br /> tCITY M 0fZ C -12 Se..,./9-71),D STATE 4....1/',4 zip ?8 d O <br /> OWNER PHONE: 2.06• $ 1O. 0 4(7 OWNER EMAIL: TA-G- 0A e.cit-44-21.., Go►"1 <br /> CONTRACTOR NAME: OW iCQ <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: ®OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 42S: g 2. 35-73 <br /> ASN E} L5-Z A 7/11-J tJ i7 At CONTACT EMAIL: 44,,A., 14-!r/- 'v, . e61/4-4:-/-4 GD ►..-f <br /> BUILDING.PERIV IT APPLICATION <br /> Existing Use of Building: 0 0 ( 41e,5h\) Contract Price of Work:$ k --1) 000 <br /> Proposed Use of Building: sV-� Heat Source: ❑Gas Ill lectric ❑Other <br /> Building Type: ®SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial [Industrial <br /> Type of Project: El New ❑Addition ❑Remodel ❑Repair ❑T.1. OSign ❑Sprinkler CI Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> c <br /> Fes',II _0 v-,(-0 F1�vt� <,,lam/ , /I-1, 1d , , Gvlx.. !.,,,h-,,,,,,,, , <br /> ASSOCIATED BUILDING PERMIT#(if applicable): epoli r eAb a(t ;vi s{`pe- tVl t str`ir5 atAct fo vvvvvi <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT-APPLICATION <br /> Type of Project: _New _ Addn _Alteration Repair Type of Project: New _Addn :/Alteration Repair <br /> #of #°f List of Fixtures List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump 1- Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater 1, Bathtub Urinal <br /> Gas Piping Boiler 2 Lavatory(Wash Basin) Drinking Fountain <br /> a... 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 /> plumber 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.lam 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 /> 2./ G1 /IS— G(A) t5it, - ooD-- <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) t <br />