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PERMIT APPLICATION <br /> BUILDING ECHANICAL/PLUMBING/SIGN/ no <br /> /DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> ,14111 .7 <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810FAX 425-257-8857 <br /> I I(E)everetteps(o3everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 'qtr OA, i�� AJC r A '( '2oi PROPERTY TAX#:®f4 3 gyg-S-p7 7 pa <br /> LEGAL for new construction: Short Plat/subdivision6 t� UI✓P /L/F1 3�s tot No2-7*$(attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (k)/LL/A-A-4 0(...„&6/1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 19 10 IZA-f/V)62 kv <br /> crlY (` 2. 77 STATE CA) pc- ZIP 9 gzo / <br /> OWNER PHONE: 4Gits-- gs OWNER EMAIL: (,t21L`/hM6X-Stq/174®0,U/Gro ..LaoA'I <br /> CONTRACTOR NAME: I-k'tM 61 1)t,5 �L L{µ.t <br /> CONTRACTOR ADDRESS: STREET P, Q, i os.. 5-7,,3 S <br /> cm, /T STATE LA) A ZIP ZO lD <br /> CONTRACTOR PHONE: q2,5-- Z,.51q'- q 13( CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED):foy,A4 5 f/DoS M9 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Aug 3 <br /> PRIMARY CONTACT: ss OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: it2-Z b'—ef$(� <br /> 601 L.L( ,uf (01.5e7Y CONTACT EMAIL: Loi L.L/Aeq L66-A( A7LDc .Cox,/ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 5 ).2 Contract Price of Work:19 60 fJ <br /> Proposed Use of Building: f1-71.1({' Heat Source: f I9Gas JEfElectric ['Other <br /> Building Type: IgSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ['Change of Use <br /> DESCRIPTION OF WORK: AOC)OD / p,A y-71 4 K, 2--c.t1 <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 r_Aiteration _Repair <br /> Fixtures List of Fixtures Fixtg List of Fixtures Fidofures List of Fixtures #of <br /> Fixtures List of Fixtures <br /> esA/C—Air Handling Units Heat Pump ( Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater ( Bathtub Urinal <br /> Gas Piping Boiler f 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 t Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: t Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan ( Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> 'Chemical or Water t !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.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> _ PERMIT# <br /> Owner uthonzed Agent Signature `Date (Revised 9/23/2016) <br />