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li II II PERMIT APPLICATIO <br /> r BUILDIN .U1I1ECHANICAL I PLUMBING/SIGN NKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> . grr 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blare or Black Ink Only Please) PF-:OJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: S2-I. IA), asint .j I lot'tad PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision _ t No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: /�, OWNER EMAIL: / <br /> CONTRACTOR NAME: -'4C-141 it ) t�GA rad Zr�t® tJ r` /--- <br /> CONTRACTOR ADDRESS: STREET Z, 5 tzAct .. <br /> �-• CITY •2.1 'J- STATE (A ZIP / a", <br /> CONTRACTOR PHONE: 2 ' :'% no <br /> EMAIL: N9t 1 I Milt—C. es Mil if) . <br /> t <br /> CONTRACTOR LICENSE REQUIRED): . CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION �p <br /> Existing Use of Building: Contract Price of Work:$ I OO,O/ <br /> Proposed Use of Building: Heat Source: CI Gas ❑Electric ❑Other <br /> wilding Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> pe of Project: CI New DAddition ❑Remodel El Repair ❑T.I. CI Sign El Sprinkler CI Demolition ❑Change of Use <br /> K D SCRIPTION OF WORK: R cmai- Q' 01.0 <br /> 1/0 1,0170( 2R-C44C it 6/44'R <br /> autzu,e‘ A— 7-ge2i( <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 611 0'2, 02_ <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 /> 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 I 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 /> curr-.t 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 /> B Idin. Official before bei .authorized under any circumstance.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> a .I co'ply with the Stark Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> / OF <br /> I <br /> l t <br /> PERMIT Floto,v2A <br /> Ow •r/Au •rized A.ent SI.nature Date (Revised 9/23/2016) <br />