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II II PERMIT APPLICATIONIII--.' <br /> #111111Pd:44 BUILDINLJ) MECHANICAL I PLUMBING /SIGN 1RINKLER/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: >nbp,(24), !w a1U'c t,,,q 9$Zo ti PROPERTY TAX#: 001-13 I'-I 3 gDZioDO <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �t s ,,,r -4- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2\l Zkt�r�l�,a�r� p,�• <br /> CITY . 61..r t STATE `^"A ZIP I o 20 I <br /> OWNER PHONE:(U l UCI g- S`1 OWNER EMAIL: 9 A+45,S'FEt„/,(}21�Cr-i��.c " <br /> • <br /> CONTRACTOR NAME: 0642^ c -{— <br /> CONTRACTOR ADDRESS: STREET - I►I - LC/1,A 10 <br /> _ cJ\gyp Ate- . <br /> CITY �v- --`Q t STATE \31-Pt ZIP 1g 2 ( <br /> CONTRACTOR PHONE: �Z�� t-1-7 gC c� CONTRACTOR EMAIL: 5' Sl'E w&+""eAS 1--• . <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: O NER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: (�� CONTACT PHONE: (kA 2'5) �1�' g'Sc <br /> v^' 'Q12-1 CONTACT EMAIL: g/�,t� S Pf4 rJ sw�PmL <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: .‘..e-,h Contract Price of Work:$ <br /> Proposed Use of Building: ss=fr--, Heat Source: 15Gas ❑Electric ❑Other <br /> Building Type: IBSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel Repair DTA. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> i)GGe�M14- et>44.. PNri c6 PCh Cp <br /> C - M- . :F1 Si . S f1 ecao, <br /> ASSOCIATED BUILDING PERMIT#(if applicable): (J►,(FL s,,,a Gpsce_yveizr-• <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 /> 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!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 /> PERMIT ERMIT#(ilv I8`Dg-OD( <br /> er/ uthorized Agent Signature Date (Revised 9/23/2016) <br />