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PERMIT APPLICATIOW <br /> -/--- BUILDING—ECHANICAL/ PLUMBING /SIGN'' RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 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 /> ` :, <br /> Z' <br /> PROJECT SITE ADDRESS: oo brat-0Jc? Avi It PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION. d,> <br /> OWNER NAME: M(t,th 1 . ( ' %frwer g- TENANT NAME(If Commercial): pip+.fr, <br /> OWNER MAILING ADDRESS: STREET �Q4,�]// 1'%De 6 l <br /> CITY fill ^ O STATE ZIP '234947 <br /> OWNER PHONE: 563 <br /> "f' 17 OWNER EMAIL: <br /> CONTRACTOR NAME: f(,114124-77 eert914". yG <br /> CONTRACTOR ADDRESS: STREET 40 4 N� `fj1 5/ . ��) 9 <br /> CITY �/( ROU;1642.- STATE •^'r ZIP ZOO O. � 97 <br /> CONTRACTOR PHONE: 4-7,v ' 4-00 452 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): 0 421-.441± CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):244— <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0-OTHER(Please Specify)Q)itel /� <br /> CONTACT NAME: C _ / CONTACT PHONE: S U. 24 Jam, <br /> cco 5cAre-( CONTACT EMAIL: '(,0 5 re_ -1 z r j ,1- <br /> • BUILDING:PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 50a— <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: CI New ❑Addition ❑Remodel CI Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 7 k s' 19 d- � <br /> 9�' - ‘d-ke"-7 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> ` MECHANICAL PERMIT APPLICATION , '.PLUMBINGiPERMIT 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 Contra .rs Law 18.27 RCW and 296.200A WAC. <br /> 1 1// ' City of Everett Official Use Only <br /> ��7/10/� PERMIT# 107 60 <br /> Owner/A." orL • •ent Signature Date (Revised 5/20/2016) 4,, <br />