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evi.____, <br /> PERMIT APPLICAI1O�I <br /> UILDING I MECHANICAL/ PLUMBING I SIGN I SPRINKLE' / DEMOLITION <br /> siiiiiiiCITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (-=Mane or ;,lack Ink Only Please) ROJECT SITE INFO MATIN iv <br /> PROJECT SITE ADDRESS: 33 1(j 1.....021 vyl O sr- AO e PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> j <br /> CONTACT INFORMATION <br /> OWNER NAME: / TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Jo`/ e--/- Pi/toff ' 4.4- Q <br /> CITY 4\M Ire,T STATE L- Jc , ZIP ''ay7e) <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: A,— ea;>t,,fit I z t( A-JL , <br /> CONTRACTOR ADDRESS: STREET 1'a � /1 U...12._ 0 DG-it'p`�. , I, o <br /> CITY /1(> v.A,) (�.1 STATE l.JCt ZIP ` !'Z3 <br /> CONTRACTOR PHONE: p?()�j 7 re" .,,c, �, CONTRACTOR EMAIL: ad t ,QjQ `i,'f-y I Z ea4- ec p6 <br /> CONTRACTOR LICENSE#(REQUIRED):AcyAmL,/'Z C 86 l,89 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 63-.- q() 7 !( <br /> PRIMARY CONTACT: 0 OWNER M.CONTRACTOR 0 OTHER(Please Specify) <br /> CNTA <br /> CCK CT NAME: ( CONTACT PHONE: `� r�`V1,(�Q Q 'Icy� <br /> CONTACT EMAIL: ole. vlRl)'! beg+, Ej74l4,r <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 2 "leo j C. 5 Contract Price of Work:$ 5-0 06 <br /> Proposed Use of Building: Heat Source: gGas ❑Electric El Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ZCommercial ❑Industrial <br /> Type of Project: ONew ❑Addition %Remodel ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ,t-.5 k r. / <br /> It) 0co �6 /0 e - ► c.-e ( a y Oc+ <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 #of List of Fixtures List of Fixtures #°f List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C–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 /> i Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/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 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> (t1c,:.1..c12 <br /> I /1 -- / �,1 8 PER�Vf It 9) t 056 <br /> Owner Authorized Agent Si na re Date (Revised 9/23/2016) <br />