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PERMIT APPLICATION <br /> BUILDING/ MECHANICAL/ PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps©everettwa.gov 1 www.everettwa.gov/permits <br /> (B ue C Black Ink Onry,:P( ase "PROJECT3SITE INFORMA Sit Tn ,:` <br /> PROJECT SITE ADDRESS: Z 0 G L,t POIz N t PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER NAME: 61J 0, C./-C'LlAi -PO TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3 2 C..."t,t.t't0 JZ N 1' - ‘7, <br /> , ��yy <br /> CITv T- STATE w ZIP Z17 1 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 110:> "1--\ <br /> CONTRACTOR ADDRESS: STREET P O ICI cH �T j y 1 T t. F � Z <br /> Tryl tt <br /> CITY L11 6✓t�N>D» �. STATE tAJ�" t J ZIP 9r! O b <br /> CONTRACTOR PHONE: 1.1Z-5 ' '7 T.4!" Ip . P L CONTRACTOR EMAIL: clt,ty e ��s o I+�T t n°�S✓1 , <br /> CONTRACTOR LICENSE#(REQUIRED) 3:16Oj„,5�, °134.E. .. CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) 05ZP-7j <br /> PRIMARY CONTACT: 0 OWNER itCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4 z. p 0 CONTACT EMAIL: �j__ <br /> q too. tM ek_. e � Y� r7 ets vt> ✓t <br /> j4„,,le �'L �I r <br /> A a . ,.,MZ ..,i r.,,< .,,.r ", B*JH D,IN ERM TrAPP,L*AT U1 s ggy,< A ,.ie <br /> Existing Use of Building: Orr)e..- Contract Price of Work:$ 219 <br /> Proposed Use of Building: °F.-P-1 L e Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ZCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ; T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: vz, S>L �£ 6,04. ( 1,) vii aS©yt s' 1� - 4gt - t-TE, <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION" PLUMBING;PERNIITAPPLlCATION , „, ,,.,. <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 it, Other: VAN,' Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER I"SUPPRESSION,SYSTEM <br /> Chemical or Water ' INo.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 /> f\-; <br /> � PERN T <br /> D� <br /> ner/Author' gnature Date (Revised 9/23/2016) <br />