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PERMIT APPLICATION <br /> #Z-7-1 <br /> BUILDING/ MECHANICAL/PLUMBING I SIGN /SPRINKLER/ DEMOLITION <br /> miligY CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 ( FAX 425-257-8857 l(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> '(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 'f1 3 I I W - "err , Ate. etiEA E 1 f PROPERTY TAX#: O #3 Tp 4 7 9ZOi/00 <br /> LEGAL for new construction: Short Plat/subdivision $1-O ' 7.9 2. Lot No./''6- (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: j)e- Ji LL TENANT NAME(If Commercial): 'Ujs lr/A1 ANN- L5 <br /> OWNER MAILING ADDRESS: STREET 14 z,g. 11Q,�P r:g / ' j <br /> CITY .TJ f,..a z,L,, A)c,,).7 jik I'! STATE L✓j ZIP g. (J , `2j-- <br /> OWNER PHONE: 3(AD 6;1 I bill! M <br /> ) OWNER EMAIL: A E. \f15tiimm,w4 .(Aryl <br /> CONTRACTOR NAME: L 6 D P5 G6 iti 6 77J,I 477 ON' <br /> CONTRACTOR ADDRESS: STREET /t fi7 a,9,1-7 D , <br /> CITY .n co Ytr d r itp (sit STATE R' ZIP 45'4,;),f6 <br /> CONTRACTOR PHONE: 4 ter"' 3 .67 1).5 a. CONTRACTOR EMAIL: /0 d ryi is 46 rhs--r)) el a 1 . G Q t , <br /> CONTRACTOR LICENSE#(REQUIRED): /0 O 41/64"I‘01 CITY OF EVERETT BUSINESS LICENSE#(REQ ED): <br /> PRIMARY CONTACT: 0 OWNER 1KCONTRACTOR 0 OTHER(Please Specify) ✓� <br /> PICONTACT NAME: c.../ .0? / S CONTACT PHONE: 4_ i 5 . 0a S 56 3 dir,J�� <br /> �� CONTACT EMAIL: i©O t'Y( /5G J AJ'ST'G-)ar9I,G LW <br /> BUILDING PERMIT APPLICATION! <br /> Existing Use of Building: eff 1 Contract Price of Work:$ c i,6-, 0 0 1) <br /> Proposed Use of Building: Q ff/e t 6 Heat Source: %Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial ❑Industrial <br /> Type of Project: ❑New DAddition )emodel ❑Repair DTA_ ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF Weiv <br /> WORK: , � AArr 1rye go r6-n gijy Z"ls' ,7-5,Nh e `, ...- A,A/66 j <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 /> Fixtures List of Fixtures Fixtures List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> 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 I 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, .• • -1 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 be•m being au -.rized 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 l comply wi- -tate Contra •rs Law 18. 7 RCW and 296.200A WAC. <br /> G\AID iCiitt y of Evee etttt Official Use Only <br /> PER3r.6I/t0 (ri`V-" — <br /> OwnerlAutho -. ' )11,gnature Date <br /> (Revised 9/23/2016) <br /> 1 <br />