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PE!-'MIT APPLICATIOM <br /> "11.1"' BUILDIal 0 MECHANICAL/ PLUMBING /SIGI =RINKLER I 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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 101/0 ? Q.I 1L,Ov2I /iO 1 D PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ✓L ( / 0 5F/ TENANT NAME(If Commercial): S 0,,)!2I Sc Fe Via S 1,,,,L., <br /> OWNER MAILING ADDRESS: STREET <br /> CRY/ STATE ZIP <br /> OWNER PHONE: ZW4 ZOp /6 J 0 OWNER EMAIL: <br /> CONTRACTOR NAME: ) WAN.I2.. <br /> CONTRACTOR ADDRESS: STREET 5 4 p4444)r S 'zj' <br /> 4-1;1°3 <br /> -1;03 <br /> crry L acz.24.s/ / STATE I) 4 ZIP <br /> 0,NN`a`LI u0' -.S.Z.- <br /> CONTRACTOR PHONE: tr 25- 7 2 9 cj z Sy CONTRACTOR EMAIL: p J� <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 'V'A-- <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR MOTHER(Please Specify) 1114/L4 0 12E)02( Co t)(-2-- <br /> CONTACT <br /> l-CONTACT NAME: A44/4/1-4;,)rQ NGcz CONTACT PHONE: /{ as -- 2._. q Z c/ 9 <br /> /144-to /2D/4 ( (`!i' z 144 0 CONTACT EMAIL: irri a ,r-' t D r a _ e'(Yl G 1Z- <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 69:"Fk. 6._4 S�c ,vl c ) Contract Price of Work:$ JO 0• <br /> Proposed Use of Building: (5�•I'M) Heat Source: ❑Gas @Electric ❑O er <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: PG • mercial 0 Industrial <br /> LS <br /> Type of Project: ❑New Addition DRemodel DRepair CIT.!. ❑Sign @Sprinkler DDemolition @Change of Use <br /> DESCRIPTION OF WORK: �1 L S T D 4� <br /> 49 N6 i r:lo,, t A 12-00/4 /-) <br /> T 1C 11)1 ‘Z IO A" o 414 61)1Loi' ' <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLIC• ` 8 N <br /> Type of Project: _New _ Addn Alteration _Repair Type of Project: New _Addn • eration Repair <br /> #of List of Fixtures #of List of Fi es #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtu, s <br /> A/C—Air Handling Units Heat P. p Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems U•' Heater Bathtub Urinal <br /> Gas Piping :oiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&D.:Dose! Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hooku.' Other: Clothes W. her Medical Gas <br /> Range Hood Water --ater Other: <br /> Exhaust Fan Sin Service/Bar/Mop/etc.) Other: <br /> SPRINKLE- I 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 co ply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only C <br /> PER lq1�~ 025 <br /> .. ner/Authorized Agent Signature Date (Revised 9/23/2016) <br /> IO <br />