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IIIIPERMIT APPLICATIONII II <br /> BUILDING J IOItECHANICAL/ PLUMBING /SIGN PSVRINKLER/ DEMOLITION <br /> grrCITY 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 /> .;:f-,-1 PROJECT,:SITE:INFORMATION... <br /> fit?J.1C.J ITE ADDRESS: PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> E� <br /> , 'CONTACT INFORMATION <br /> OWNER NAME: 5A12O IACki'i?Kt t'1 <br /> OWNER MAILING ADDRESS: STREET .5-17-7g.(4 <br /> TE^NANTpNAME(If Commercial): <br /> 2 ? c rcv r� i q� <br /> CITY e/'C C'C- STATE �� ZIP GL s J� <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: ©4,-. to lU' /� <br /> CONTRACTOR ADDRESS: STREET <br /> y�5rJ, �" 7r9 D. t-eV pc ve. e /� <br /> CITY JCS[ e'rC ! ` STATE c4 ZIP 9 P ZcD3 <br /> CONTRACTOR PHONE: ,2©Co 5-5-j 6? 2`7 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: • . <br /> . . BUILDING PERMIT.APPLICATION,i . .... : . .. . _ rg <br /> Existing Use of Building: Contract Price of Work:$ 1�7 1 5.e <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: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> fk 9,e, Cil e(e kb ,eo CAA to 1 -(e),vd tikot.Ls e_ ©. er Peet.,_. <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 #°f List of Fixtures #°f 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/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.lam 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 La 18.27 RCW and 296.200A WAC. <br /> ( . City of Everett Official Use Only <br /> PERMIT /7-, <br /> V LP—D --4 t 2 <br /> Owner/Au prized en i ature Date (Revised 10/12/2015) \.._J./ <br />