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PERMIT APPLICATIO <br /> 401#11 '_ BUILDIN-CHANICAL/PLUMBING /SIGN IINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVIC <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 /> �RIue or:Black Ink Only "Ieasej; <br /> r: i SITE,IIMIP+ R11lIATIQi , ` . .. <br /> PROJECT SITE ADDRESS: 72O(CJ r k b or�. PROPERTY TAX#: 60 Li-1;23 o®Oi/00. <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copyof long Ie9al description) <br /> ) <br /> CON <br /> .. TACT;;iNfaRMATiON <br /> OWNER NAME: E4 ryvL.> La ,-. (7,( , TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET '7,Q O( , t;.P.c)uPf Q 1 Ut1 <br /> CITY U.tk STATE KA ZIP <br /> OWNER PHONE: (e0, c..1.--), 011-3� OWNER EMAIL: <br /> CONTRACTOR NAME: S r\k , <br /> n l� 1'A t,c�Ki-s k(A,-'�L- <br /> CONTRACTOR ADDRESS: STREET /(""C? <br /> >) S 1(:1-1. Y /()7 <br /> CITY nil t V\11 �---e,Y ) STATE ill la ZIP e���- <br /> CONTRACTOR PHONE: '3(ec) (-( 3 i ��.7,p, 1 1c CONTRACTOR EMAIL: (S f‘,„(-1 h /n 41 h„4L�,,( /')r( '/ <br /> CONTRACTOR LICENSE#(REQUIRED): 514 A IV(� /i-1 ao T CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): _'�/ f <br /> PRIMARY CONTACT: 0 OWNER QtONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: 4 <br /> ul,tevJ€' v- ' CONTACT PHONE: <br /> : -73(-Pf <br /> CONTACT EMAIL: <br /> (c)/1A/)j') P,2F A',,",71 (;) o <br /> � � �f�il,-LYL <br /> BUILDING.PERl11lIT APP,LICAr,IOi� ",,.: <br /> Existing Use of Building: ,5?"e_, Contract Price of Work:$ 5CYCDC. ('}-4) <br /> Proposed Use of Building: Heat Source: \pas ['Electric ['Other <br /> Building Type: LFR-Detached ❑SFR-Attached ['Duplex ❑Multi-Family-#of Units: ['Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition El Remodel CI Repair ❑T.I. ❑Sign ['Sprinkler ['Demolition ['Change of Use <br /> DESCRIPTION OF WORK: <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 _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 /> I 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. <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.lam 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 the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Owner/Autflorize"d Agent Sig tur Date (Revised 5/20/2016) <br />