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PERMIT APPLICATION <br /> "IIP BUILDING/MECHANICAL/PLUMBING I 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 I(E)everetteps ageverettwa.gov I www.everettwa,gov/permits <br /> (Bine.or Black Ink Only Please) i 'PROJECT SITE-INFORMATION <br /> PROJECT SITE ADDRESS:gat V) t&) ,.. or PROPERTY TAX#: 47,1errf <br /> LEGAL for new construction:. Short.Plat/subdivision Lot No. (attach copy of long legal description) <br /> _ CONTACT INFORMATION <br /> OWNER NAME: ( t i,,Q--) TEN T NAME(If Commercial): -'""`- <br /> OWNER MAILING ADDRESS: STREE?.,,,, <br /> (, r _ <br /> CITY STATE ZIPCAI:7 <br /> OWNER PHONE: 9Z-5- e�►1 -- .? OWNER EMAIL: .013(1614 r �`, C o <br /> CONTRACTOR NAME: _ d 11J _ Cl67 1 Jr - plc •• + J� <br /> CONTRACTOR ADDRESS: STREET f NE ( - <br /> CITY it'ea STATE -17,4- Zip c7606)--. <br /> CONTRACTOR PHONE:44-54 °— 39i -`7_, CONTRACTOR EMAIL: *pa( k frit ` fi rid <br /> CONTRACTOR LICENSE#{REQUIRED):ALL C to(.6` CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Lia. <br /> PRIMARY CONTACT: 0 OWNER .CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:jCONTACT PHONE: 1 P}r"_ Lip, 30 7. /� <br /> UG+ CONTACT EMAIL: l-jl t �C"t I#r,[f 1 <br /> BUILDING PERMIT-APPLICATION' ."' _ , i <br /> Existing Use of Building: Contract Price of Work:$ , t <br /> Proposed Use of Building: ��/ Heat Source: ©Gas OEiectric ❑Other <br /> Building Type: ❑SFR-Det hed E6 -Attached C(Duplex ❑Mufti-Family-#of Units: ❑Commercial ❑industrial <br /> Type of Project: ONew ddition ❑Remodel ❑Repair OT.i. OSign ❑Sprinkler ODemolition OChange of Use <br /> DES IPTION OF WOR `: .16 czy,f_vio, <br /> i c <br /> ASSOCIATED BUILDING. RMIT#(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 #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 ,k Unit Heater Bathtub Urinal <br /> 1 Gas Piping C('o or,' 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 /> Chemical or Water 'No.of Heads <br /> ACKNOWLEDGEttk :I have review s application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federal,state,a •local law.Then"g of a permit only authorizes approved work'and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official bef mre be g auth 'Azrim r'any ircurnstance.lam the owner,or!am authorized by the owner of this property to perform the work for which application is made, <br /> and t comply with,1he -t Cont L 18.2 RCW and 296.200A WAC. <br /> PER <br /> s City of Everett Official Use Only <br /> , <br /> '/ 97 / <br /> NiI <br /> Owneri4thori d_Agent Signature ''Date (Revised 9/23/2016) <br />