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PERMIT APPLICATION <br /> BUILDING!MECHANICAL IPLUMBING I SIGN /SPRINKLER!DEMOLITION <br /> /IPOO -----g CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa. ov/ ermits <br /> 9 P <br /> (Blue or Black Ink Only Please) . PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ZAP-( co L fryj.Pc.,4_ iQ-t/ (Jt PROPERTY TAX#:2153651160)2C41360 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)A j-/4 eII ) <br /> CONTACT INFORMATION <br /> OWNER NAME: Do/s (,)$A TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Z$j q LOL...tim pir is 4'.-V ,JV.. <br /> CITY evg aLr---Tr-- STATE LotAY- . ZIP C;)43 21)3 <br /> OWNER PHONE:C�ZS) 32- 3 U' I `7 OWNER EMAIL:004 g6.N OSA (tCa0 ki4 Orsrl2 r rior b-,f©,- <br /> CONTRACTOR NAME: ' -e-2___.F <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR UCENSE#(REQUIRED): CITY OF EVERETT BUSINESS UCENSE#(REQUIRED): <br /> PRIMARY CONTACT: IXOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUIIDINCG;'PERMT APPLICATION 1 <br /> Existing Use of Building: !Apr-. .. Contract Price of Work:$ f <br /> Proposed Use of Building: ( O VC 12- Oa-K. Heat Source: DGas DElectric DOther <br /> Building Type: DSFR-Detached DSFR-Attached DDuplex DMulti-Family-#of Units: DCommercial Dindustrial <br /> Type of Project:f2tNew DAddition DRemodel DRepair DT.I. DSign DSprinkler DDemolition DChange of Use <br /> ms q <br /> DESCRIPTION OF WORK: J2E , <br /> 4� Jy. Tom._ -n r��..�..y. 106_ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> Aic &P 1/92— - , <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 #°f List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC-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.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 Con ctors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 474.-- <br /> PERMIT 1 f1 D 00 <br /> -----L <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) l <br />