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045.77- PERMIT APPLICATIOL$ <br /> BUILDING..- IECHANICAL / PLUMBING / SIGN ' 'RINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET.EVERETT,WA 98201 <br /> cP)425-257-3810 1 FAX 425-257-8857 I(E)everec eps`a'�,everettwa.aov I www everettwa-gov;permds <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: .11-12,9 b0 e(ii Lane, a Rye* 61941bROPERTY TAX#:00Zcror . <br /> LEGAL for neve _traction' Short Plattsubdivision Lot Nc_. _ _ tattach copy of long legal descnptioni. <br /> (, CONTACT INFORMATION <br /> OWNER NAME: -�ACY lar1 . Jf i- I f int (mj e r TENANT NAME (If Commercial): <br /> OWNER MAILING ADDRESS: STREET /q2,14 ev e♦n 11 ✓�(_�ie:, <br /> CIT13 Y ere-H- t STATE W f DP gXzo -. <br /> OWNER PHONE: 642-c) &-OLD52 OWNER EMAIL: p+1-1 mry12,C1 t gmv{ ' It.. cf., yy1 <br /> CONTRACTOR NAME � � t <br /> CONTRACTOR ADDRESS: STREET <br /> CM, <br /> sr.r_ <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 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: S 1 en c----- <br /> - <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric Dottier <br /> Building Type: ❑SFR-Detached ❑SFR-Attached DDuplex ❑Multi-Family-#of Units: ❑Commercial ['Industrial _ <br /> Type of Project ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ODemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: .XNew _ Addn Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures s of #of <br /> Fixtures F;xtures List of Fixtures Fixtures List of Fixtures List of Fixtures <br /> Fixtures <br /> ASC-Air Handling Ur,.. -leat Pump Toilet Backfiow Preventer(Inside Bldg) <br /> j -orced Air Systems Unit Heater Bathtub Urinal <br /> I 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. Ot`-)er: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> :aierr.,cai .`'.'ater I No.of Heads <br /> ACK(rJ,,V LEDGEtAENT ;rave reviewec this appication and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply w,tr <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 /> _ <br /> City of Everett Official Use Only <br /> PERMIT# <br /> / /2q / 7 -v� i1 � D <br /> 0 d(o� <br /> ,e.', .-1-:-"Authorized Auutthorized Agent Signature Date (Revised 9/2312016) <br />