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PERMIT APPLICATIO ' <br /> ,001)14Ti• BUILDINdIIIIIECHANICAL/ PLUMBING /SIGH 'RINKLER/ DEMOLITION <br /> **1°111111V <br /> I/ CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 IFAX 425-257-8857 I E everetteps@everettwa.gov 1www.everettwa. ov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE'INFORMATION <br /> PROJECT SITE ADDRESS: S 41S fletzggrzett. \HAI' PROPERTY TAX#: 00&q 3 L.001o0SOZ. <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ` 1 ('� CONTACT INFORMATION <br /> OWNER NAME: 60,,,c1,.‘ C0VLLWIUytI yv\ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET P.O ( <br /> OX '?j .?j0/ <br /> CITY SVlft STATE YVk ZIP /WO <br /> OWNER PHONE: S ZS— SS"?-5462, OWNER EMAIL: j a$C •01/k COOtS /IL•C on <br /> CONTRACTOR NAME: J <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: t5 Contract Price of Work:$ S.0) COO <br /> Proposed Use of Building: j Heat Source: 181Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: El New ❑Addition ❑Remodel ❑Repair T.I. O1Sign El Sprinkler ODemolition OChange of Use <br /> DESCRIPTION OF WORK: I` pAY'}� aoors Qr n et,) O G<s <br /> I` 11a„vvi <br /> calk ctAce. <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 /> 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 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 /> PERMI5N�vl w ..D34 <br /> u%_- ifye3A1/15 <br /> Owne/Authorized Agen ignature DHte9/23/2016 Revised <br /> ( ) <br /> 111 <br />