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��III PERMIT APPLICATION' BUILDIN�MECHANICAL/PLUMBING/SIGN I IIERINKLER/DEMOLITION CITY OF EVERETT PERMIT SERVICES ,41 .1/111.1 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps©everettwa.gov I www.everettwa.gov/permits (Blue or B1601Cimk Only:Please) PRO;IECT SITE INFORMATION PROJECT SITE ADDRESS: TAX#: �l ,41 uc�c�ri 'Rik)dPROPERTY LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT„INFO.RMATION. .. OWNER NAME: DaG Lel TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 173w Zetc9 c r- S c CITY 6tfcre--4- STATE (./q" ZIP W-k OWNER PHONE: 4 — ��LS OWNER EMAIL: d4\0. 3 42kj�-y►�Q.�,,�n� CONTRACTOR NAME: Al1 Pa }1e„„4„,„4-0. CONTRACTOR ADDRESS: STREET 433 2— Ghe,nrt4.4.` CITY r rV1yRy ( STATE /, /4- ZIP 5V-2.75— CONTRACTOR PHONE: ( CONTRACTOR EMAIL: ^i' j( , J-j CONTRACTOR LICENSE#(REQUIRED): ,L�L(,,Ik�P1-q Q(-c CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):OI -. GCo S PRIMARY CONTACT: 0 OWNERla'CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: 01,013 Lail('Curti CONTACT PHONE: 4/ CONTACT EMAIL: CA4 pis L. 1(fu'rl , vh .. BUILDIN IT APPLICATION Existing Use of Building -� Contract Price of Work:$ �(��. o, Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: heiP'et lots ►' ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL:PERMIT APPLICATION 'PLUMBING PERMIT,APPLICATION Type of Project: _New _ Addn jZAIteration _Repair Type of Project: _New _Addn _Alteration _Repair #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures Fixtures A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) / Forced Air Systems Unit Heater Bathtub Urinal f Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeration Shower Floor Drain Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas Range Hood Water Heater Other: Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: SPRINKLER;/SUPPRESSION SYSTEM Chemical or Water I INo.of Heads 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 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 Building Official before being authorized under any circumstance.I am the owner,or lam authorized by the owner of this property to perform the work for which application is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT gl (ToOL4.9 Owner/Authorized Agent Signature Date (Revised 9/23/2016)