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PERMIT APPLICATIOI— <br /> #11111."* BUILDING I MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 I(E)everetteps@everettwa.gov 1 yrww.everettwa.gov/permits <br /> (Blue or Black ink Only,Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: r1DO 6-AA-a( �UJL PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: f� q TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET "dO( <br /> cm( ��� STATE ZIP l'�Q/ <br /> OWNER PHONE: Ya 5 — /750 OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: y.„7 5 - 3 9'M-66 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR ._la'6THER(Please Specify) );(944:7e- <br /> CONTACT NAME: % // �/`-- CONTACT PHONE: G2 g <br /> , CONTACT EMAIL: 7 4A.,1 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 5 /2 Contract Price of Work:$ IOOOb.� <br /> Proposed Use of Building: Heat Source: as DElectric ❑Other <br /> Building Type: ❑SFR-Detached SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: El New ❑Addition model pair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: / <br /> �G(�i�G/� �cL 4,5 /7,1 �--�'�-f� �-t� oaC <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 /> 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 /> 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 aw 18,27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 1 ' 61 d� <br /> Owner/Authorized Agent Signature D to (Revised 5/20/2016) <br />