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PERMIT APPLICATION■ <br /> elP,"/P--,. BUILDIN! I MECHANICAL/ PLUMBING/SIGN I SPRINKLER I DEMOLITION <br /> 41111, <br /> CITY OF EVERETT PERMIT SERVICES <br /> iiil <br /> N ����' 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 l FAX 425-257-8857 1(E)everetteps@everettwa.gov l www.everettwa.govlpermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 3 7 2 3 /fort ive. I"i e e7y952 6/ PROPERTY TAX#:G 6%'6 ?96d I dfil <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 722 7 t{,yi- ve.-. LGL TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1(,S7f Lf/I.7f. f/. I.rerf' <br /> CIT ` ' <br /> Y Ly 4 4 o'4 � STATE f,✓4 ZIP 9P-7 7 <br /> OWNER PHONE: 2. G Ce -2 Pp-,776( OWNER EMAIL: ad/1Q•4 • G'/ ,, S(9'5A4','.GoMM <br /> CONTRACTOR NAME: L eL.vt 9 &'g 6,04./.frZ c $';._G t—6 , <br /> CONTRACTOR ADDRESS: STREET / 7 77 s, Pildli ,�iv4 P/./ lie,fiy <br /> CITY P4 /414:9? 4 STATE k4 ZIP (1,4,73 <br /> CONTRACTOR PHONE: L-11.5-..-77O- 40.7r40 <br /> CONTRACTOR EMAIL: 4 Y4`I6.,.z e c-4 4 t' d, ` .-- <br /> CONTRACTOR LICENSE#(REQUIRED): L4-4134T E 171"x7 CITY OF EVERETT BUSINESS LICENSE#(REQ -ED): <br /> PRIMARY CONTACT: 0 OWNER Jg CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: // CONTACT PHONE: LI`,P.- 70-. O,?fO <br /> f3A-40(/gZ.ea4 G4. CONTACT EMAIL bYaiolk Z..ech 0 4&9n+4,1. 6047 <br /> BUILDING PERMIT APPLICATIONExisting Use of Building: ,/r 111 Contract Price of Work:$ l a, 40" <br /> Proposed Use of Building: he-14/ L 64114-4 4-be 4 Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: DSFR-Detached ❑SFR-Attached ODuplex DMulti-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ONew DAddition DRemodel DRepair ❑T.I. ❑Sign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ,. I <br /> d yy� I,�, v )4v C-04-1-74" `�a' <br /> p.e%o e rAii TCR 'f , <br /> TO <br /> TNI t702�/F <br /> ASSOCIATED BUILDING PERMIT#(if applicable): " v '"'G'.`K �– - --� <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 /> A/C–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/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 /> 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.I am 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 /> OwnerIt 'e°1/ J—1. it PERS \ `OG s <br /> Authorized Agent Signature Date (Revised 9/23/2016) <br />