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PERMIT APPLICATI <br /> BUILDII— MECHANICAL I PLUMBING /SIGN /SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> „vit 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: '(Qd1 4-1. c'4 W,& ',hi-E.. A-3 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: h••LW t�t�la�l,�C1DY�I. jZ I' 1(�e�T NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Z!Z 2L>f'�(/r!��C�(�{ `�.p -17 (Vi `-/� <br /> cm' j(/L((4 �-7P�y`I t STATE Y ZIP ,DS?•Z <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: -- - -_ ".••••• C-rM <br /> CONTRACTOR ADDRESS: STREET 44b4040- 4600:1 <br /> G+t ' <br /> cm' (qt fl STATE WA% ZIP 4)$2,p( <br /> CONTRACTOR PHONE: 949'_454 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED):am,IGC./02.... 1. 4 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 2.71$7 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ' .OTHER(Please Specify) 1 2 .I-(Ct1=L3 <br /> CONTACT NAME: CONTACT PHONE: �(/jGj , , Asa. <br /> CONTACT EMAIL: ,t4 ,yti'7ct -lhar^G ,Gql <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 1404 066. !�Q <br /> Proposed Use of Building: dE=7F(C Heat Source: Was ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: (Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition 'emodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> I l-'( 'Iz - - izoa-bvL 4.r uxt-9-rti16, sut tv- <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.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 /> PERMITiL <br /> - i b06 <br /> ( 1:1: <br /> caner/Authorize Agent Signatu Date (Revised 9/3/2016) <br /> 1/ <br />