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PERMIT APPLICATION <br /> BUILDINGI:ECHANICAL/ PLUMBING /SIGN r RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> .„4 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue Or Black Ink Only Please]:'.w . . .: _PROJECT SITE INFORMATION w <br /> PROJECT SITE ADDRESS: .21 -1 W ""n•A( A'S Av���)� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> _ .: CONTACT.INFORMATION.. . .. . .' <br /> OWNER NAME: .(`(\-. 'L U.– W t st ( TENANT NAME(If Commercial): tJ rAll\ e_Ot ' <br /> OWNER MAILING ADDRESS: STREET 2412�1��{V� <br /> CITY STATE vV ZIP <br /> OWNER PHONE:• 1. OWNER EMAIL: NlAZ(W"�L <br /> CONTRACTOR NAME: %Fte, C\4at4 CZT -Ot4 PCIF-NWIr. <br /> CONTRACTOR ADDRESS: STREET et1 Z- tl)MDNI> . \NA`fQ(�/y�� <br /> CITY . ,VIVA4 y. <br /> STATE 'Pr' ZIP 1007 -l7 <br /> CONTRACTOR PHONE: 24(51o...41$. CONTRACTOR EMAIL:rl'iVi Fie.-- lbt4TOtr-@ MstJ.601•/1, <br /> CONTRACTOR LICENSE#(REQUIRED): tPA�C�\�SE �t to CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR OTHER(Please Specify) ,P t'4 'C' <br /> CONTACT NAME: rPhglp (�► ttzt� ��, CONTACT PHONE:A i 44�. y4444 <br /> Bcmt 0 CONTACT EMAIL: rA-'Lpc Am%kopc�"m,61:1.4 <br /> BUILDINGPERMITAPPLICATION <br /> Existing Use of Building: 2�� j Contract Price of Work:$ � ��• �� <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: CI New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> I \OC l 1 notvr/AA Ce f Co. sl <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 /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #°f 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 /> 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 /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I 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 /> S Lin PERMIT# �^I� D9, � i\ ,Iz <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />