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OrEn- 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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only,Please) PROJECT SITE INFORMATION <br /> X PROJECT SITE ADDRESS: I2p$ ct2AFI-S ti/Vi 5-rg_(o9 I:vF.I¢ti--T PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> X OWNER NAME: .....3 ot-t.. L a t4-0 t...) TENANT NAME(If Commercial): fjt_of-1.J oire,2 J is-ryc.u..)y <br /> OWNER MAILING ADDRESS: STREET 12,05 CCtA.P'TSr4.A... t A. =I.a9 <br /> CITY V y-rr STATE L)4. ZIP 98Z.0( <br /> OWNER PHONE: 206v 3 b 9 0?3 9 OWNER EMAIL: t N so S3 yv ,i,rsTrlGrnay , ce•4. <br /> CONTRACTOR NAME: G.L t= — P€C—br2,v"1 <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: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$_.OD.� <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair DTA. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: e->< rD„oc. F IS.n,Q4, ,,,t,ar ee- SUPPLY P02- Go+te.l Gu¢.w4 <br /> 74. <br /> Z, t=x' J. b FiJti v K.A6 T7 1•)4, GI 6 ?PL-y C-dZ r'J n�4 L <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ‘J Cr4 AMSu L .1/Al—ye-- <br /> MECHANICAL <br /> ALve- <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 /> A 2 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 /> 7 Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups ✓ Other: gQOSLeg.' Clothes Washer Medical Gas <br /> Range Hood Water Heater • k/ Other: Ex t? ex%11/43/4 44.4--€2. <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: 5.,PPery tCvrt <br /> C i.* 3 t 4::•%,1J.j <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 /> PERMIT# <br /> y SOLI - 0014 <br /> rized Agent Signature Date (Revised 9/23/2016) <br />