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I <br /> PERMIT APPLICATION <br /> el/PAV-_,....A BUILDING /MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> gi- 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) elrt.(>✓ PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:(42/Z Ili d&r ,, r t' 9''3� PROPERTY TAX#: 00546 12 023 Oen O 1 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> /// —ie. <br /> CONTACT INFORMATION <br /> OWNER NAME: y\)..t t, ?DO\!O Q . / � 7 e, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREETT1167 pact Arc., '€ <br /> cITY EA//4/2„ .P <br /> STATE ' � ZIP 9-gz,.6 <br /> OWNER PHONE:L{ZS- q (0 6 OWNER EMAIL:t IAivi l/rfeit CkVtf'ecil diC r apri <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ,OTHER(Please Specify) PrOftf.44j aleti 1' .C., <br /> CONTACT NAME.77"t22v>i-ra-Co M 2t -17?1 CONTACT PHONE: 3347.-6,24" <br /> rS <br /> ✓ , pL I "T I`(Z .0 CONTACT EMAIL (AOjji le '� ittaktO Itch sm)Tc' (171/1, <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 1-6-o0: " <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: El New ❑Addition ❑Remodel El Repair OT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: lGt lK. ),_t n-1 `JI^ite h 1 <br /> IM.i SC - ��ii�Nl� �(Jp11�1"G!V 'I I GIG�Q �9.frt Ot>✓ � '���G{�y�,(e�6 I',j�`P/. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> `� ,`t i CI 'V` , �s 1 1 et� K <br /> , <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 't Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater % Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> iWater Heater Refrigeration I Shower Floor Drain <br /> Gas Fireplace Wood Stove I Kitchen Sink&Disposal Grease Trap <br /> Y Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups t Other:9 , 1 Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER 1 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 - :y with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> ler <br /> iiri, Cityof Everett Oficial Use Only <br /> ` ha 1/7 PERMIT# /� Il V �lr -41k, U t/ <br /> 0 .• /Authorized Agent signature guy Date (Revised 9/23/2016) <br />