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PERMIT APPLICATIO <br /> BUILDINCHANICAL/PLUMBING/SIGN " INKLER/DEMOLITION <br /> /1111--g <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 i www.everettwa.gov/permits l <br /> (Blue or Black Ink Only Please); PROJECT SITE INFORMATION: <br /> PROJECT SITE ADDRESS: ,i-t b I Jj(LOi?-,V VJ il-Li PROPERTY TAX#: d 04311 43Y1 sl¢4 o o t 00 <br /> 4 6-t I2LA <br /> LEGAL for new construction: Short Plat/subdivision EV T f.2PPUC`%No. r g 2...(attach copy of long legal description) ,Sec.54444-T , <br /> CONTACT INFORMATION <br /> OWNER NAME: Pi 0 t Dj12„pmock)tl,f I.I--e— A t TENANT���ccNAME(If Commercial): TiM S taat! 5t-1e(' <br /> OWNER MAILING ADDRESS: STREET H. ILIg Mf-�-pI%,-YEcU( • 311-11-6-14 .,{ n ¢ q <br /> CITY f V 0 f10f 5 r l STATEy ,1,O A ZIP qU�tO <br /> �1224 OWNER EMAIL: Dtt/YLCI? rytt 1/U1�6Sea4tO_, GBrvl <br /> OWNER PHONE: �Q(! ,� <br /> CONTRA,. _ � <br /> CTOR NAME: i� z .-; I _: _ --,, -� /'f —�� ( : �r 4�. f IU V Mil <br /> CONTRACTOR ADDRESS: STREET .11- I L{o 1 hlt h lV4 c. <br /> CITY `� D 'f 1, t STATE 1,,U / � <br /> T ZIP q T ` ' 6' <br /> CONTRACTOR PHONE: 2,0 b' gin-. 22,ei? CONTRACTOR EMAIL: Pez,tA L° yt4& 12&-Sei I+et,, OWl <br /> CONTRACTOR LICENSE#(REQUIRED) M K't'O0-C SL.15 D( CITY OF EVERETT BUSINESS LICENSE#(REQUIR=D. <br /> or <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) (10t /,(-1 1 <br /> CONTACT NAME: CONTACT PHONE: zt, 0 <br /> CONTACT EMAIL: b e ' ■. -5e-&- „ 6-6. <br /> 74,1 <br /> .,. BUILDING PERMIT APPLICATI <br /> Existing Use of Building: M Contract Price of Work $ LO I at-0 <br /> Proposed Use of Building: M Heat Source: ❑Gas Bglectric FA Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached CI Duplex ❑Multi-Family-#of Units: =1 ommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition CI Remodel ❑Repair XT.'. ❑Sign ❑Sprinkler ■ 'emolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> pm Vick_ ike,w- w--rv(; y aeCla'k- l/Y-si 'v-aIAA 110 12: i,14le-e-SART <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 _Adds Alteration _Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures <br /> A/C-Air Handling Units Heat Pump I Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler 1 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 0Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION-SYSTEM-----------vi•---- ✓ A9'` ••• `- %,1 i 11 <br /> Chemical or Water I No.of Heads lC /, ,` t- } <br /> ACKNOWLEDGEMENT::I have reviewed this application and confirm the information contained herein is true a d correct.W done pursuant to this pe it must comply with <br /> current federal,state,and local law.The. rantin of a permit only authorizes app • -• ndcand-no-d viations therefrom.Dewations must first be authorized in writing from the <br /> �Buildinq Official befor baing-autherized-und any circumstance.I am the owner,or lam authorized by the owner of this properly 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 /> . <br /> \bovvt, <br /> Pet 27) 201g.' Ili ' '110.1r00 <br /> Owner/Authorized Agent Signature Date (Revised 9/2,poj,¢) ©l r 00co <br />