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II PERMIT APPLICATIO <br /> BUILDIIVo) MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: a s 1 H Loi.) 14 t2) Ave. PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ?..\ST' SN-NEE L e - TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 25\ tzto PcIZ p AV E• <br /> CITY EV STATE J3 Pr ZIP 'Act2 O` <br /> OWNER PHONE: 20 c — `1 9 3— 0 OWNER EMAIL: <br /> CONTRACTOR NAME: flit t'e-SON.1 I 1,0$'c p L.f}1\O N <br /> CONTRACTOR ADDRESS: STREET g 02-7 t3Q 0A9 t33 F}� <br /> CITY 42-Vrr y1 STATE U ZIP q to O\ <br /> CONTRACTOR PHONE: (t Z i-!5) 2S " `-i kzA. {� CONTRACTOR EMAIL: F P. 06�'D EizS p ovv,a * C Y►'\ <br /> CONTRACTOR LICENSE#(REQUIRED): A I\J D E R.rt 9(p I L T'CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):liCX161tef <br /> 1 <br /> PRIMARY CONTACT: ®OWNER 0 CONTRACTOR 0 OTHER(Please Specify) 669 <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 1 gift r <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 ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> go_ ...f.L® cf- c c3 a S wct'k S` b �- c ode_ S�\re.. `re.�pl�cam. <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 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 /> + / la/s//d/� PERMIT it(,o0 <br /> %wer/Author) ed Agent Signature ate (Revised 9/23/2016) <br />