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PERMIT APPLICATION <br /> BUILDINIIIIECHANICAL/ PLUMBING /SIGRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> (4:77 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION ; <br /> PRQ C/o TE AADDR,,ESb 4 gv� _ W 1� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: a4e ijbi j p.�j TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /D 5� 3 P° Ave <br /> CITY f1eeer ".. STATE 1J4 ZIP 9130T,-,5-075X <br /> OWNER PHONE: (JOcD ...,.Y©2 e%,/ OWNER EMAIL:`J . : ._ .. . <br /> CONTRACTOR NAME: -V<' L(3" ?::›I tie <br /> CONTRACTOR ADDRESS: STREET /o / d.87 <br /> CITY eiegZ - STATE ).510)-- ZIP g ea o <br /> CONTRACTOR PHONE: 4:42:—ICI. I— 06-5-7 CONTRACTOR EMAIL:64-E E/ Ih2Q (""a <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: in OWNER ❑CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: c-1--&—\/„.— L,o � 6 b� CONTACT PHONE: (�©& , -34( — <br /> CONTACT EMAIL: --4.s- SEL j i @ /i tern , .OW\ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ j,rnt <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: ElNew DAddition CI Remodel ❑Repair ❑T.I. DSign El Sprinkler El Demolition CI Change of Use <br /> DESCRIPTION OF WORK: e Oc lerr vJ ' 7�.T- - 'p44IZ 1013 <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 #°f List of Fixtures #°f 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 /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM;:: <br /> Number 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 Off cite!before being authorized und- - circumstance.lam the owner,or I am authorized by the owner of this property to perform the work for which application is mad,., <br /> and I comp with the State Contractors L- 7 ROW and 296.200A WAC. f <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 3 42 3 t v ( te,0"1-- 00 <br /> Owner/Authorized Age Signature Date (Revised 10/12/2015) <br />