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PERMIT APPLICATIOI—" <br /> /14PBUILDil +hInECHANICAL/ PLUMBING /SIGN I l#WINKLER/ 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: `I,/5 Mc- 0v,.c-1cJ1 44)e. PROPERTY TAX#:O0y-,sy2 600706 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: gvt..e&W s cAr-, J? 4 I(,1..f(...4TENANT NAMEA] (If Commercial): <br /> OWNER MAILING ADDRESS: STREET /OZ et Mc- D , r t,e� 4,// 4(..'€- <br /> CITY ffif`e,✓`Qi`- / STATE W 4' /ZIP 9 Z' ( <br /> OWNER PHONE: 4/Z,s,neZ- 73(7 OWNER EMAIL:�cot,c f� 1$1- CPL. e rroht Gv. Cam <br /> n <br /> CONTRACTOR NAME: f-v 2-ci-e 2,o— G.7-vi. S+TrIA-()I %"el <br /> CONTRACTOR ADDRESS: STREET '110 3 '� f d p r, 74...g., 11,74 <br /> -7 <br /> CIN /iarys2� /4 ,I STATE 4.. ZIP {,74 / 6 <br /> CONTRACTOR PHONE: 4126----e-122,—?-70 r CONTRACTOR EMAIL: dr-i-y—44.44—Jeb QC6icu-54-. '/€1.- <br /> CONTRACTOR LICENSE#(REQUIRED): ME GSE 117 C.E 1 (' 0 Ll.., CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 124 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> �/✓� CONTACT PHONE: [�1zs_t f 2— �7 Z"8 <br /> c^`�' ' P��Gwl,a CONTACT EMAIL: a, w`44_.de,b&Cor►nc<.5�, pi-e-it-- <br /> BUILDING <br /> d <br /> BUILDING PERMIT APPLICATION <br /> /.e i G Price of Work:$ e S-.. Av�o, C�UD "_6. <br /> Existing Use of Building: �.�S Z d � sf �8 4.1;6,Contracti <br /> Proposed Use of Building: 5.,1VL e 5FR t Heat Source: IRTGas ❑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 CIT.!. ❑Sign ❑Sprinkler <br /> - ❑Demolitionn ❑Changeof Use <br /> DESCRIPTION OF WOR (/ CZ6��c9c est 5 ; pL�jQv +� /ya.BT. „ LGdrao� <br /> � <br /> 0.— met, rev- h�1kt "l n-rw e tos �s <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn XAlteration _Repair Type of Project: _New _Addn 2CAlteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump 1 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler 1, 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 /> I 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 /> �`?� "y City of Everett Official Use Only <br /> '�/I PERMIT <br /> ,4• .�-1 ��'� (�,� 05- cos <br /> Owner/Authorized A ent Signature Date (Revised 9/23/20M <br />