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PERMIT PPLICATIOI—' <br /> '- BUILDING l MECHANICAL i PLUMBING/SIGN JNORINKLER I 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@everettwa.gov i www.everettwa.gov/permits <br /> (Eke or Black rok Only Please) PROJECT SITE INFORMATI� N <br /> PROJECT SITE ADDRESS: O APROPERTY TAX#:GY(`((00007700 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATI(.,N <br /> OWNER NAME: 12AT—eleK ym. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 14 4() /4'L(,p,2 <br /> CITY eVefZe r_ STATE LAJ 11,. ZIP O <br /> OWNER PHONE: ‘{2.5j--1-1,Q-----?'s 7 OWNER EMAiL: <br /> CONTRACTOR NAME: DA" N 1TE ('L-Nmgl rJ G 1-- /-1-saarrm <br /> CONTRACTOR ADDRESS: STREET f 1IC'('1.1 13 a 1_,t) • � <br /> cny J'v�(-0 co Q STATE w ZIP q O3 / <br /> + <br /> CONTRACTOR PHONE: (It,`I CONTRACTOR EMAiL: ,S 1I D O 1�I('���$J PT <br /> CONTRACTOR LiCENSE#(REQUIRED):DAVAr.A44411 JC.Q CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 114-74-1 <br /> PRIMARY CONTACT: ❑ OWNER 'CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ytZr775__t,K c <br /> 2A��� /� CONTACT EMAIL: 7 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ t j,r57©i <br /> roposed Use of Building: Heat Source: Ikas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached FR-Attached ❑Duplex ❑Multi-Family-#of Units: El Commercial 0 Industrial <br /> Type of Project: ❑New DAddition DRemodel ❑Repair DTI. ❑Sign @Sprinkler ❑Demolition @Change of Use <br /> DESCRIPTION OF WORK: RectAce � 6.1 5 7 J 0oi_ce <br /> j� .547rYl - L- ,ct l loA ) ,,‘)c) 6 S to)P tc <br /> ASSOCIATED BUILDING PERMIT#(if applicable): V <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn X .iteration _Repair Type of Project: _New 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 /> 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/SUPPRESSIQI< 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 /> —rrent 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 /> _wilding Official before being authorized under any circumstance.1 am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> �hd I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> l�f City of Everett Official Use Only <br /> RMIT <br /> or 0/ �f !/ ate� ! / PE 7{ — O1 <br /> Owner/ thorized Agent Signet - (Revised 9/23/2016) <br />