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47TP ERMI ll APPUIC.A.TI <br /> BUILDING I MECHANICAL I PLUMBING I 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 /> Q •Iage or Mack link®halt'Please) PROJECT SITE I i'FORMATION <br /> PROJECT SITE ADDRESS: .�.��ct RQ�-t _Ar. PROPERTY TAX#:004yto( 8 S'(OS(x) <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CsNTACT INFORM ATII N <br /> OWNER NAME: 5fl m.,In Catkr ' TENANT NAME(If Commercial): NI A <br /> OWNER MAILING ADDRESS: STREET 30oz) d tcj Lick ins '1O 4 1 <br /> CIN STATE ZIP Ci riD•Ci f <br /> OWNER PHONE: '?5.— Mt- 34 U OWNER EMAIL: <br /> r 1°••NTRACTOR NAME: k•"1\l 0.• . Q..k._ , r c_ . <br /> •NTRACTOR ADDRESS: STREET � <br /> Li S t-54 `PI,oLa... 9 <br /> CITY �� `'� STATE ZIP l gl s <br /> CONTRACTOR PHONE: a4C1(0—alkqp 9 1 Q 0 'CONTRACTOR EMAIL: <br /> 'CONTRACTOR LICENSE#(REQUIRED):`40L to 13"19 A!-O "CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) <br /> PRIMARY CONTACT: 0 OWNER *CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NARK.: �n�lr�. CONTACT PHONE: 1.1495. 33Q- 8`d0L► <br /> ,1T CONTACT EMAIL a ,. b it f X)1 c..&f •I <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work 4 dw, 000 <br /> Proposed Use of Building: • Heat Source: %Gas DElectric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: 0 Commercial ❑Industrial <br /> Type of Project: ❑New DAddition DRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition <br /> DChange of Use <br /> çCRIPToNOFWORK �\�� .0...my‘ e�co4 . t • cp .�.,,t R 0 <br /> *0 i .wikCit, \n 4c� 4h1.. b Appero4.‘ . ' S Ido -4 <br /> �' 1- 1, �� vSt\ieN ° ' -e 1ev`ga fa.,alr� . '--"" ct �A ' ' c� . <br /> ASSOCIATED BUILD PER #(if applicable): <br /> `,Gs <br /> f 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 /> NC—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub• Urinal <br /> I 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 I Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water 1 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 properly 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 /> t City o/f Everett Official Use Only <br /> 16., I to( 1 PERMIT#(` l U ©,� <br /> 9 3/2016 <br /> Own: horizedliti t Signature ate (Revised1 ) , S_ <br />