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PEi"MIT APPLICATION <br /> BUIL•ING /MECHANICAL./PLUMBING /SIGN/SPRINKLER/ !IEMOL.IIION <br /> CITY OF EVERETT PERMIT SERVICES <br /> ti 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: ts40c) It J ,' JP���. PROPERTY TAX#: O C4-3 rim/ ()lap <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: &am• C���1c*�irl TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRE8: STREET 0196-- trietk- i.e_ SIE <br /> CITY LK, ."'"'`-g STATE cuZIP c l J <br /> OWNER PHONE: ,61. 56`— OWNER : rr , ; y� i " LOLW <br /> CONTRACTOR NAME: --g,�1 QrO a��t e' +f <br /> CONTRACTOR ADDRESS: STREET 4 ,Ok9DU 13 it* ii <br /> CITY \„ L, kl, STATE+ Ak . ZIP tnin <br /> CONTRACTOR PHONE:�b co— j ) CONTRACTOR EMAIL: /I ` ,Ica r f y OA, L(/' 0',C©fyl`.' <br /> CONTRACTOR LICENSE#(REQUIRED): 6 ' t"pa(4& 590,8 sr, CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):mil0o <br /> PRIMARY CONTACT: 0 OWNER ONTRACTOR ❑OTHEReci Please Specify) <br /> P �Y) <br /> CONTACT NAME:Le.--0' * • (Sob CONTACT PHONE: 01 06—1 j— 633l'k� r1v & Q) CONTACT EMAIL: /1/4.,1 V,f? r .tea i- • ILS_.ckpr, <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ Y a/ 32-0 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family #of Units: ❑Commercial ❑Industrial <br /> Type of Project: El New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTIONWORK: 1'0°6 <br /> r A,-' j 64?../..) <br /> J� <br /> // ~ r A414.4•14(41- <br /> l(4 q) PQM. ,�T yr , +iLB 6fkvad 0 <br /> v" <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 #°f 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 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 law1 e 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 auth.hr ed 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 thSta� e Cont ors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 1 Ii •. r 1. <br /> 7215 <br /> D (Revised 9/23/2016)��� �'o #) <br /> Own �t A nt ig atu e <br />