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> PERMIT APP UCATIOi <br /> BUILNINC /MECHANICAL/ PLUMBING I SIGN I SPRINKLER I DEMOLITION <br /> ir CITY OF EVERETT PERMIT SERVICES <br /> '' `'' ''c' 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 /> (1 lime or Mack link©arty Noose) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: •fyt' / 71-, f7- ? - PROPERTY TAX#: I;),o‘ -2,i ''L2/0 IQL'7 <br /> (LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT (INF©i'.kVjATI©[M , <br /> OWNER NAME: /,dl/ � TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET (4P1 P <br /> CITY 5 1` G✓ .` STATE 12..1* ZIP q 767..- <br /> OWNER PHONE: [OWNER EMAIL: <br /> CONTRACTOR NAME: 41/ /7 �'' f- 7:217 /' <br /> CONTRACTOR ADDRESS: STREET 6...(5-4-"" ° ( 1 16-'.1' -- <br /> CITY d .i7.�2.9'Tl e STATE ZIP 9,eMC 2 <br /> CONTRACTOR PHONE: * 1%114, CONTRACTOR EMAIL: a lJ , G I deep`e _ - ° �,y'4 <br /> CONTRACTOR LICENSE#(REQUIRED): A I" ,5 of f.2E <br /> 60 r70 CITY OF EVERETT BUSINESS LICENSE#(REQUID): �� ``'' 4c-l <br /> PRIMARY CONTACT: ❑OWNER ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: A CONTACT PHONE: ..,0/4-4) <br /> 1, CONTACT EMAIL: " c raga,F <br /> DILDING PERMIT APPLI©ATI•N \ I <br /> Existing Use of Building: j Contract Price of Work:ti /-14/ <br /> Proposed Use of Building: $ a. Heat Source: ❑Gas ( ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commerc' I ❑industrial <br /> I <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑RReepair DTI. ❑SSiign��❑DSprinkler Demolition ange of Use <br /> DESCRIPTION OF WORK: �l.° 6 -e Rer t di--,A # 5 l tr- ' <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MEC 'A I©AL PERMIT APPLICATION PLUMBING PERMIT APPLI©ATIs N <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 I Fixtures 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 /> 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 /> SPGR(re KLLER/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 au r-ized-atnd-r 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 withjlie-8taafe Contr. ...f--aw 1z. 7 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> -' .00.1... PERMIT VACP- <br /> L <br /> 4t, <br /> 1110 <br /> , Owner/Authorized Agent,Signature Date (Revised 9/23/2016) <br />