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I IIIIII,, PERMIT APPLICATION I.. <br /> BUILDING J IEECHANICAL I 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: IL 1 8 Par K Place PROPERTY TAX#: 00(0 2060002()0 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 4C or SCNA lue.�Qi('' TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 41% Pow-1e... ?1c c'. <br /> CITY u-ere..- " STATE W ZIP X18203 <br /> OWNER PHONE: 4Z5-- `i3D-5-3-9`I OWNER EMAIL: CAIS bbb Cowt CccS+,YI,e-1-- <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS UCENSE#(REQUIRED): <br /> PRIMARY CONTACT: rfrOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: Cl'1,(Ciev- S ChlL e4e.Y- CONTACT PHONE: (126 -g-3-6-s-3.5 ct <br /> CONTACT EMAIL: CHS bbb 0 CowlcaS4 .ne_ - <br /> BUILGING PERMIT APPLICATION <br /> Existing Use of Building: S\ingte. "FAvhj`i3 ((jQy . Contract Price of Work:$ 4 7 RQ.00 _ <br /> Proposed Use of Building: Sjy� e w�ljy ov Heat Source: t5Gas ❑Electric ❑Other <br /> Building Type: iNSFR-Detached ❑SFR-A ached ODuplex DMuki-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel laRepair DTA. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Rejlaced, VItcl- c,3c v- k-a.vtic_ <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 /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures <br /> NC–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 /> I 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 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 /> .Q91V:-k&J SCSIAA - 0 /3112©Ig PERMIT#MA 61 <br /> O^61 G <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />