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j��� PERMIT APPLICAT'-I I <br /> #.41PPI1/40 /%-- <br /> BUILDI1 ILII/ MECHANICAL IPLUMBING I SIGH 1 SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> Niiii ' ' " 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> (Blue or Black Ink'Only P?ease)`- „PlROJECT SITE INFORMATION !1 , ..6-4,-',. , s ,. -, . <br /> PROJECT SITE ADDRESS: ?To 6, 51 Sf SA-' S v.) PROPERTY TAX#: GG im 000006 <br /> LEGAL for new construction: Short Plat/subdivisionS,y/r'&$ get ediK" Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION ; , <br /> OWNER NAME: ciao `6 & ' 4 (-Q,* TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ZSt)� ///��<)tit- .5•(- S(A) <br /> 7v crrA---� cry Why tT1(,/�r�v,\ STATE ZIP 19 Z03 <br /> OWNER PHONE: ( 20(0) c S- 6-7 0 I OWNER EMAIL: '12)k ,c;64, o my 6 a(tali ,Cow\ <br /> CONTRACTOR NAME: '4(A4 Ilk G — 1,E. -r <br /> CONTRACTOR ADDRESS: STREET SSD (,Pilel (Dr%k(•e, <br /> CITY Ft <br /> U - e STATE Op._ ZIP e'YOZ <br /> CONTRACTOR PHONE: q14( • ie-2 • /q-7 fo CONTRACTOR EMAIL: yjOt ® fa,a ,rACX _Wis�'. Co no, <br /> L <br /> CONTRACTOR LICENSE#(REQUIRED): M,-jti,,,!4... ${2 P J CITY OF EVERETTTSINESS LICENSE#(REQUIRED): _,{40t�'f <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) 41"(.t7j LLt 12-0 l(.0 <br /> CONTACTCNAME: y.a. <br /> CONTACT PHONE: c.( . PcZ • /Cj"7'� tK b roCONTACT EMAIL: fel ifQ,y�J Glc, �,e5 7--.CO rvl BUILDING;PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ /it/OS 0• OO <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel I Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> /r -&c t (1) Pr(v-e,n i les 4-o Si-ado i tilt' n e-oJc-i a(l • <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 #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 I 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 owe 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. -,,^'S\I'V <br /> City of Everett Official Use Only <br /> tf <br /> PERMIT# <br /> v <br /> I��/� � C� ^020 <br /> ner/ uth ized Agent Signature te (Revised 9/23/2016) <br />