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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> grr <br /> li <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 li <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits 6 <br /> (Blue,or Biack Irak:Only Please) • PROJECT SITE'INFORMATION <br /> PROJECT SITE ADDRESS: 1 Hz 0 1-46w1 1 yr PROPERTY TAX#:oo1-13e1( R,ow o o <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) 1 <br /> CONTACT INFORMATION ,_ , <br /> OWNER NAME: HY 1WaS+1 44,3— L.It''''llreD TENANT NAME(If Commercial):Texestig 13dIVi.e. <br /> OWNER MAILING ADDRESS: STREET 1310 g �{Sq1., -'r , III <br /> CITY M UK II Yee, STATE e // T ZIP yG~� I <br /> Try <br /> s <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 6+s" HeedTiti q <br /> E Jae`G` <br /> CONTRACTOR ADDRESS: STREET 3110, <br /> CITY EV&e-r STATE kiii/A ZIP etgaO' l' <br /> CONTRACTOR PHONE: L2s----3Qot- 64-o-7 CONTRACTOR EMAIL:3`OV/Ogt/mVt7GSHPssYI ; t <br /> CONTRACTOR LICENSE#(REQUIRED): 65aji*Cf3cfRto( CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) Cf 61? - 1 <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: i{7.6- 3 c - ro? r <br /> Te. ve44,7 Fey-bert ..0 CONTACT EMAIL:3`v,„,ta7uc...,..,elp .� 1,/�4.•t-(V! . cOtvt <br /> 1 <br /> BUILDING;PERMITAPPLICATION - 1 <br /> 10 Existing Use of Building: Contract Price of rk:$ OV <br /> Proposed Use of Building: Heat Source: ❑G ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ercial ❑Industrial <br /> Type of Project: ONew OAddition ❑Remodel ORepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Qe r pve./s Per iowov� <br /> tt�t <br /> II <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> .+s MECHANICAL,PERMIT APPLICATION PLUMBING PERMIT;APPLICATION I <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 p <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 t <br /> Gas Range 7 Ducting Dishwasher Roof Drains I <br /> I <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:1 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!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 WAD. <br /> City of Everett Official Use Only <br /> f% g -3°.-1-r <br /> �11�T# <br /> PER k -a Z O `.J <br /> 'Authorized Agent Signature Date (Revised 9/23/2016) <br />