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�IIII PERMIT APPLICATIOI—" <br /> BUILDIIIL J MECHANICAL/PLUM:-,ING/SIGN JSilbRINKLER/ 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 i lack Irak f Fnly =lease) PRsJECT SITE INFORMATIIN <br /> PROJECT SITE ADDRESS: ' 10 5C bU ere" �, ,1 IA) l PROPERTY TAX#: 067100 344 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Co 4 p e1)1t.51/ -th4- l-,c) 1„/. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET I S b wv.e t,1 I(e> V.E Su & 4 <br /> CITY 1.A.bkoylAo161A STATE /j)4 ZIP <br /> 5.‘e.) <br /> OWNER PHON5.‘e.) ' j g7O OWNER EMAIL: v 1J <br /> CONTRACTOR NAME: GI/t /W��y <br /> CONTRACTOR ADDRESS: STREET l 3 31g 4. 53 O <br /> CITY T <br /> 4-1)i�r L" STATE ��` ZIP ! '?-Y1"3 <br /> CONTRACTOR PHONE: �‘O 435 55;S ' J CONTRACTOR EMAIL: ) y�u6l�t�le/11U Yrr�i lith(325Oka; <br /> �1.�Y� <br /> CONTRACTOR LICENSE#(REQUIRED): Thf r .T"S P l (b` ]`� CITY OF EVERETT UBUSINESS sLICENSE#(REUQUIRED):ii/91,'3 <br /> PRIMARY CONTACT: IH OWNER 0 CONTRACTOR 0 OTHER(Please Specify) �+ <br /> CONTACT NAME: CONTACT PHONE: c/25 330 %I O' <br /> 4.V e <br /> ))\, CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> ou <br /> Existing Use of Building: Contract Price of Work:$ q ,\ <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 0T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: II <br /> Otkejln:1vi loratk►raw 61K it <br /> ASSOCIATED BUILDING PERMIT#(if applicable): /.70g. _0/5 <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 V 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 1 comply with the State Contractors Law 16.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 006 <br /> Owner/Authorized Agent Signature D to (Revised 9/23/2016) <br />