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IIIIII PERMIT APPLICATIO <br /> BUILDII I MECHANICAL/ PLUMBING /SIGN PRINKLER/ DEMOLITION <br /> 111110704//'—'—‘ 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@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Pllease) PROJ CT SITE INJFORRMA ON <br /> PROJECT SITE ADDRESS: (�. �t© DEQ=q PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ,.'/ _,,,-` , <br /> CANT <br /> ACTT11�1 ORMATION <br /> OWNER NAME: Gwv W 7Uk 1( NO-00k:E1` � `" TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 23 (jZ A- 4(lE /J . SM. (DZ_ <br /> ��r` ff <br /> 7,,� STATE _t4J,4' / ZIPnOWNER PHONE: �2 ) e20 OWNER EMAIL: RA" I' / Ger.L Ir -QV <br /> CONTRACTOR NAME: /.S •w g9,,,,,„,t, <br /> MIL.` i ,, LI-C-- <br /> CONTRACTOR ADDRESS: STREET F E (D24. W\\ CITY �y�SSTA 1- ZIP Teaa <br /> CONTRACTOR PHONE:( ) � CONTRACTOR EMAIL: ►ci�-r>/ii'YI �C (C4 :I <br /> CONTRACTOR LICENSE#(REQUIRED):// # it s�3c7 Y41) CITY OF EVERETT CBUSINESS <br /> S LICENSE#(REQUIRED): t � <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) /At IG <br /> CONTACT NAME• , icer Q CONTACT PHONE:(c •';i I b <br /> <S tt'n'y <br /> P14'4 6.-(ai <br /> ""`I i CONTACT EMAIL: (VC/1Ply(,' C@ '1eF <br /> BUILDING PERMIT APPLICATION - <br /> si -r <br /> Existing Use of Building: Contract Price of Work:$. -___!.2.6j; <br /> Proposed Use of Building: • • Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑DuplexAulti-Family-#of Units: 90 ❑Commercial El Industrial <br /> Type of Project: ❑New ❑Addition PfRemodel El Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Cha�Up <br /> DESC IP ION.OF WORK:__ �� -�I tier Cin 4/ d ! / <br /> raciJ7 ce4J ` — iS-EgnAtc r <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 13"1�Q`�6^2.3 <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 Unit Heater Bathtub Urinal <br /> 1 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 /> Chemical or Water I No. 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 befor-being aut orized 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 .,mply with the Ltate Con actors Law 18,27 RCW and 296200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Own., orized Agent -ignature Date (Revised 9/23/2016) <br />