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PERMIT APPLICATION <br /> ,I.fr^/--_ BUILDING I 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 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECTagetiginiggednarignitantatrORWIWir*Tt INFORMATION..,...:;. ` .. _.. _ <br /> PR SI2 ADDS; SS .-��� ,,/e7 ! PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Gf Y Lot No. (attach copy of long legal description) <br /> RatairgaMENSEMSENSERWONTATIKONIMATIOCRingagengeggiMattaMESE <br /> OWNER NAME: C��- ,4 d // /4 ANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 37L.--!l --. 7 1174aZZ h)0/ <br /> CRY STATE 0, ZIP 9e,-Or <br /> OWNER PHONE: l///JG�Z, - Z 4' OWNER EMAIL:.44/70,40,61/4.57-(40_.._.__... /4' <br /> CONTRACTOR NAME: ,4 7,05 E i 4-; le"/c <br /> CONTRACTOR ADDRESS: STREET 14/EO3 i//uV 47EJ 4240 /� <br /> CITY OZ/A/Z STATE /,4 ZIP 702i-6 <br /> CONTRACTOR PHONE: 1.�J� 9 9�oV CONTRACTOR EMAIL aj f �2.J.Biz. <br /> CONTRACTOR LICENSE#(REQUIRED)MEW, Z 9E Le... CITY OF EVERETT BUSINESS LiCENSE#(REQUIRED C 7 <br /> PRIMARY CONTACT: 0 OWNER ikt CONTRACTOR 0 OTHER(Please Specify) ! <br /> CONTACT NAME: CONTACT PHONE:I,L2 <br /> / <br /> 1) /,l //17- - CONTACT EMAIL 14 BJ7 <br /> , :-= . x ..i . _ . _. _.. B,WtlDINGwPE.RM,i.IT,APPLICATION . __- N` <br /> Existing Use of Building: �j� Contract Price of Work:$ to,do 6 <br /> Proposed Use of Building: /00 i )/i //1 ZZ i Heat Source: gGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached El SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial El Industrial <br /> Type of Project El New ❑Addition ❑Remodel ❑Repair Alp. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> L// 1 . ,/c7-- pe , • - . _ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): /-3 j' ' 2/ <br /> _. arMECH I_NICAL PERMIT APPLICATIONEM .g... _.:,... .s_.` PLUMBING PERMIT'APPLiCATION R. ;:_ : _ <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 /> SENSPRINKLER/, 00#0SION_Sftab r,.,t <br /> Number of Heads <br /> ACKNOWLEDGEMENT•l 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 onty 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.lam the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and I com ly with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ‘112, PERMIT# <br /> Owner/Authorize gen Signature Date (Revised 10/12/2015) <br /> I <br />