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PERMIT APPLICATIC _ <br /> BUILDIr MECHANICAL/ PLUMBING /SIGI oRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> • /44-77. 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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: $1(0 glm. W ulir.l ;- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 5TLhr%".. eilcsap&AAt,tC� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET irpt to amt),_ Vit,t4' bk. astt. <br /> CITY spel ()mil) STATE epr ZIP Gsu22, <br /> OWNER PHONE: (i *41-*VI" OWNER EMAIL: A„,s,pp. <br /> CONTRACTOR NAME: c,rnQ eitNS'(R,t(GI1ni l <br /> CONTRACTOR ADDRESS: STREET llZO I sr pi, SW <br /> 1 CITY W`NN yV nit STATE W k Z I P q'tOt7 <br /> CONTRACTOR PHONE: (4s)%7- ,%7'7 CONTRACTOR EMAIL: ah lVi011011 • <br /> CONTRACTOR LICENSE#(REQUIRED): e100„.00 ACIOT ak- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):t cSiit(o <br /> PRIMARY CONTACT: 0 OWNER I CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (Alc) '', <br /> ttkiku Pirik41 CONTACT EMAIL: Chain se. /mat' .6",\ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ y. 4L,°- <br /> Proposed Use of Building: Heat Source: ❑Gas MElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex FMulti-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel t5i32epair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ' 1 "c ,kms 4 .yo(i, ( „tut awt% dp u <br /> a11. &bt <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 #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 /> 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.lam 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 /> PERMIT#3121111 I 1 03-63(0 3'63(0 <br /> Owner/Authoriz d Agent Signature Date (Revised 9/23/2016) tt <br /> 1 <br />