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PERMIT APPLICATIt <br /> BUILDMtl J 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 /> (Blue or Black Ink Only Please) / PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: /6(.<"---) 1' 1 (UST)ZY -5r iJ PROPERTY TAX#: :200e/ 3094VQ41 013 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: j DOt4/'Q STo1i), TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREETPG80)( <br /> CITY e_605 STATE [/, ZIP <br /> OWNER PHONE: yob-407-0 )07 OWNER EMAIL: e/50<1/1/1° t'J�orGtiaS4ne,corn <br /> CONTRACTOR NAME: 51i7/rl/ F//aa <br /> CONTRACTOR ADDRESS: STREET //:_ f r// <br /> CITY -mG'V�/"'t STATE �/ ZIP ce fJy� <br /> CONTRACTOR PHONE: ' ac/2- �? CONTRACTOR EMAIL: /Cf�� .f4,�5/14f1/6re,&211 <br /> CONTRACTOR LICENSE#(REQUIRED): jiM/rt1'fS/3GJ 7 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER 'CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: -t-G rF <w cr1-1. CONTACT PHONE: g5.3-a/sa i/e <br /> j <br /> J� CONTACT EMAIL: ( , ei,fL P,cr,�lt�{fy�,(�pn) <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 44/1/4/, Contract Price of Work: $ 7i 28. <br /> Proposed Use of Building: M/-)/I/`/, ,Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. OSign ❑Sprinkler El Demolition El Change of Use <br /> DESCRIPTION OF WORK: /l OD/Fy 1HE Ex'&Ti y(r sPeav eitksysrEin 7s ibccommoonTEThE SP2.1V i3 TH <br /> /,t//-(/t< /f*5 BEEn) GoivfE1zr p 70 A cstZbVtD)v b- Ttm/h <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 #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 /> SPRINKLER/SUPPRESSION SYSTEM <br /> d. Number 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 /> City of Everett Official Use Only <br /> /717/7 PERMIT# <br /> Owner/Authorized Agent Si nature Date (Revised 5/20/2016) <br />