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PERMIT APPLICATIO <br /> BUILDIIIvnECHANICAL/PLUMBING /SIGNPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 l(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> p't0.SECT•;S1TE�IN:0..QRMATM01tn7W , <br /> PROJECT 5IiQDCRES ��rt Scam .A PROPERTY TAX#: <br /> LEGAL for new construction:ttShort Plat/subdivision Lot No. (attach copy of long legal description) <br /> :•::•f::: ... . ..1... :: ... .. : : .:..:.: .,. . • TAOT:INF`.ORM,KThON.:,::;::. ::''.:`r :i:'::.`:.-: :;: : ?: ::,;;;,: :.. <br /> OWNER NAME: TENANT NAME(If Commercial): 7 k*s\� Yom* <br /> OWNER MAILING ADDRESS: seer <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: `la yL 4 w/Le./4e <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> • <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR x OTHER(Please Specify) (-c1V)...1N. <br /> CONTACT NAME: CONTACT PHONE: 4afy es Oa <br /> 5 CONTACT EMAIL: G yT$ k,S .e.c•. C i°C. <br /> . ,. :_-:_.�.:....::::.:,:::r.:;:.,:-:: �...J'- :APPLICATXQN;;-:�;;s ;::;-•.::.:r.:•;;..:�::�:�;... <br /> , r- ;::::-:=� .:: UILDIht,C�•:�PER.,My'r`. ..... _._:...-._._.... .... .... . ...... . .. .. .... . .. ... . <br /> Existing Use of Building: Contract Price of Work:$ S600-d <br /> Proposed Use of Building: Heat Source: EIGas @Electric OOther <br /> Building Type: I:SFR-Detached ❑SFR-Attached ❑Duplex OMuIti-Family-#of Units: ElCommercial ❑Industrial <br /> Type of Project: @New DAddition @Remodel @Repair 0T.I. EOSign OSprinkler @Demolition ,Change of Use <br /> DESCRIPTION OF WORK: Mel"-, TL N 1 •jt•- SNI s v A,- &it4`-" , ` '_c <br /> 01J1v(>4L, __tc(41 (NG MA 70c,t1 MLA <br /> ------I-27.--7' — <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> • `' "' 00.P MIT fPLI$ATI <br /> • ME�HANIGA'L P�ER'�AIT APPLIt3QT10N-I:;;`,;;.:: : •-....P,Lt71V�::_.. . ..�.E;R `AP ON <br /> Type of Project: New Addn Alteration _Repair Type of Project: New _Addn Alteration _Repair <br /> #of #of List of Fixtures #of List of Fixtures <br /> Fixtures List of Fixtures #of List of Fixtures Fixtures <br /> 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 /> ::•: ;::;: :500NK,00;4SUP:P4,41O1N:SYSTEM a;;,.1:: <br /> 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. City of Everett Official Use Only <br /> Ilk 1 _� PERMIT#Aillioirma —aid ik. e__ __). (r2 ad i@ -FP /10060- 0s&, <br /> Owner/AuthorT ed A.•nt Sign.to Date (Revised 10/12/2015) <br /> eta <br />