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PERMIT APPLICATION <br /> #141 <br /> BUILDING/MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITION <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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION. <br /> PROJECT SITE ADDRESS: ,/"4.Z �,,01 b9 KCL/ PROPERTY TAX#: 60 •""4").R,1-b26O13ED <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �h c r+i h'1 l TENANT NAME(If Commercial): 6# !/! <br /> OWNER MAILING ADDRESS: STREET 1 j" .i 1 &® 7 cae, ',El <br /> CITYrI)e rft/9f STATE (IJ, ZIP Cat 80 Zit <br /> OWNER PHONE: 360 LI 2,6 2.4 -- OWNER EMAIL: <br /> CONTRACTOR NAME: i /8144 4 W j //V.'''.CONTRACTOR ADDRESS: N�YSTREET !) 6 'd oG'-gL ^ <br /> , <br /> CITY STATE ZIP 'yD //jo <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR (OTHER(Please Specify) OR1 <br /> CONTACT NAME: CONTACT PHONE: A 7 67v 13,o <br /> CONTACT EMAIL: <br /> BUILDING:PERMIT APPLICATION,.:. <br /> to <br /> Existing Use of Building: .),-72,/, „„,k._...,/..„,„ Contract Price of Work:$ `O(OOO: <br /> Proposed Use of Building: e,„ /24/LIVT— e.. Heat Source: ❑Gas Ptlectric ❑Other 129bIS7"' <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial ❑Industrial <br /> Type of Project: CI New ❑Addition ElRemodel ❑Repair FT.!. ❑Si ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: novil Ve40 ,9, 41 y - <br /> gta- t9rovv4-- f ✓ , <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 #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 I SUPPRESSION SYSTEM". <br /> Chemical or Water ' 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 circumstance.1 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 /> N, City of Everett Official Use Only <br /> ` PERMIT# <br /> ► .. 1- I '3 61-76.1.... a�q <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />