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IIIIII PERMIT APPLICATIOM <br /> #14111.1*40‘/%1;:g <br /> BUILDIIJ tJ1MECHANICAL I PLUMBING I SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> vtirtird <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 <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1tiz6Q k-ca4c 4 ;(4 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ,i ,AAt)f-s-ime LLL. TENANT NAME(If Commercial): ?���j(� /fj . e '� <br /> OWNER MAILING ADDRESS: STREET Oc-. (3241 <br /> cm' fVQre_t- STATE /AA ZIP 9120 6 <br /> OWNER PHONE: 4,- ?-3O-2561 • OWNER EMAIL: veci , 9 -s4401. (61,4(CONTRACTOR NAME: U <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR rxOTHER(Please Specify) <br /> CONTACT (i <br /> NAM 1 CONTACT PHONE: f('_ 5-2_2- 32_13 <br /> aq `l r ",d/l/mfgq CONTACT EMAIL: kjuoteiLe.. f'lie I to A/'4ASobfia cam;I.C+> [ .1 <br /> c <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ g©k_g'6Q- f�4c10 <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: . ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler Vbemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> piM6 Q N �+ LY1C bathhtrod wts F i eesr 6t� 6 kit) <br /> vC(., .O,C CjAA <br /> o <br /> i <br /> Tkfie(fOr Nth(r4 14 <br /> au(4 _. <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/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 /> 1 PERMIT# <br /> 09 <br /> %Authorized Agent Signature D e (Revised 9/23/2016) ` ' i <br /> le <br />