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4:77 PERMIT APPLICATI a <br /> BUILDII�ISIIECHANICAL/ PLUMBING /SIG ii T-RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERV = <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE_INFORMATION .:. <br /> P OJEC ITE D S 49:6P RgArY7 TAX <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> r..; CONTACT INFORMATION , <br /> OWNER NAME: ��ej7e- 4a-� � TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Z3 77 1- 2 9 ) "A /(-2__, ...--..-/9 <br /> crr' r.., �iA ( STATE %G/ `, ZIP ''2 ✓ <br /> OWNER PHONE:`7 � 7 3 `6� OWNER EMAIL: �E �1��' J/ / ..sUU U..�s Cif <br /> CONTRACTOR NAME: D G d �L/P( �. //, + <br /> CONTRACTOR ADDRESS: STREET /7��� z2_f.0-6 £ /(/ <br /> CITY -5�� "e#7,0017 STATE U Z 9 ZIP 'fG / <br /> CONTRACTOR PHONE:,y�) f X "/74-2.... CONTRACTOR EMAIL: -- 7,,i,ge9jf/ <br /> CONTRACTOR LICENSE#(REQUIRED):141-4/41/ ..,7 C--6. CITY OF EVERETT BUSINESS LICENSE CREQUIRED): <br /> PRIMARY CONTACT: 0 OWNER `CONTRACTOR MOTHER(Please Specify) re.,/,/,SC-.- <br /> �/ <br /> CONTACT NAME: j� CONTACT PHONE: ‘,./../f -0..<6'.-5:--0..<6'.-5:- 7. <br /> /? (//e/ GSL � <br /> / �-%C�v/ CONTACT EMAIL: / i.. , .�/ ��5-Qf/` tsJ <br /> BUILDING PERMIT APPLICATION " , , £ LL„ <br /> Existing Use of Building: ��� ( r,,,,,...._,.. ,--,// Contract Price of Work:$ 3 �Proposed Use of Building: �l/ ��6Heat Source: ❑Gas 0 Electric ❑Other <br /> • <br /> Building Type: FR-Detached ❑SFR-Attached El Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: .41. ew ❑Addition 0 Remodel El Repair ❑T.I. ❑Sign ❑Sprinkler 0 Demolition ❑Change of Use <br /> DESCRIPTION OF WOR _-- ����� ��._� <br /> I V v seW(l ,e4 / isA�si>/ll/LIFE'/t/i�,.�...ri�r- <br /> ,r,,a ftw ' /"A . <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 AV.Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of 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 i !T --S 3 fi <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,th:State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> # <br /> PERMIT <br /> --.. '-ie‘' ,1(alO 3 — o 47 <br /> 11 <br /> ner/Authorized Agent Signature Date (Revised 10/12/2015) 47, <br />