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PERMIT APPLICATION <br /> A� BUILDING/MECHANICAL/ PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> 1111• 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.govlpermits <br /> 4 <br /> 4 <br /> PROD/c.°T2E ADDR , T, 4v PROPERTY TAX#: ®O 4,,4.49( 6,3 az)3 60 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> .wYa.::,. __':: ;CONTACT INFORMATION. R:�_.,..REEMME.. M <br /> OWNER NAME: TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZiP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: ?g 6 D ` c y ,/1nLA t e.4-1'L,O <br /> CONTRACTOR ADDRESS: STREET /48'3 I5f._ 324 Sr <br /> cmr STATE ZIP G4JJ '? <br /> CONTRACTOR PHONE: 7...S -?3:5-gO8 3 CONTRACTOR EMAIL: /1/1P/2666 G A-6 L. C-474-1 <br /> CONTRACTOR LICENSE#(REQUIRED): SC.7 L r 3 95 6,1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):637f <br /> PRIMARY CONTACT: D OWNER IZCONTRACTOR O OTHER(Please Specify) <br /> CONTACT NAME: // CONTACT PHONE: 20 c.3 04 <br /> -3;44242-4 C I.F Po -i- CONTACT EMAIL: "3,4/242y.6 Q..Pp s3eis-re-Lec +Li p n , cks <br /> anatatiMiginitZIMMEVERRIAIOAKOWRiatiCkitWATtiONVOMMerintaMEMEMERMOS <br /> Existing Use of Building: "B 4-v/e--/c f/ Contract Price of Work:$ f•• DOD <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: OSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: New ClAddition DRemodel ❑Repair OT.1. ❑Sign OSprinkler ODemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> i4--A fRoc..4e <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> wEAMECHANIcAL 1:00170/►PP!JCATION , . , _ mg,, ;:-PLUMBING PERMITsAPPLiCATION_A_ NSMS <br /> Type of Project: New_ Addn Alteration _Repair Type of Project: _New Addn Alteration _Repair <br /> #of List of Fixtures #°f List of Fixtures #°f 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 /> n_ 11-4 N_KLERJ.SUPPRES TOT V iti a g <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 1 am authorized by the owner of this properly to perform the work for which application is made, <br /> and!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMI (`r.D. 0 <br /> Owner/Au. •dAge •nam Date (Revised 10/12/2015)) <br />