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4E7 r PERMIT APPLICATIC <br /> BUILDII IECHANICAL/ PLUMBING /SIGI^ PRINKLER/ DEMOLITION <br /> CITY 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 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: . PROPERTY TAX#: <br /> 70 L' ", _sr. o o S3 6 y oo0c>6)7©C) <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: c 06/2-i Gfr{ 37 2/L.)1 6/e___ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET y7oy EZ-/7 sT- <br /> CITY E l//2G7 7— STATE t„,/.4ZIP 9�SZ©� _ <br /> OWNER PHONE: 4/15--Sl 2— 3 9'70 OWNER EMAIL: x/2/:•0 G/i, /2./L//T//2(0G^1r9iL. CaM <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: AOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 417-5-- �`/2 -3 9 7o <br /> / z /G{/r/rz_ CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: SfCL Contract Price of Work:$ 3©/000 <br /> Proposed Use of Building: _$/=72__ Heat Source: OGas ❑Electric ❑Other <br /> Building Type: PCSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑ : <br /> New ddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WOR <br /> P , I-ST?/i-r rvbisng-keZ ..5c)/9. _ -400/77vet/, /,✓e_i_va/.-lrl. 48‘,0/200"/ <br /> ,34720G,11 / .'4G4-(7/h/ cGo., G , 4.4L-mc/-i- - /2-00,-1, 4-wo /2`co v�iG-,..,,2,9?w4v v/- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): / XrS/-l✓+iC, IPO2G/ <br /> .. .j ,MECHAN,I,CAVOERMIT,APPLICATION._, ,.. ,; .. ,.,..:, ,... ., PLUMBING PERMIT°APPLICATION ` <br /> Type of Project: _New _Z Addn _Alteration _Repair Type of Project: _New ,Addn _Alteration _Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures <br /> A/C—Air Handling Units j Heat Pump 1 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> r 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 /> 2_ Clothes Dryer Hookups Other: -7 Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> 2_ 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 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 /> / / PERMITft j 1 5 I2 l I 1 �� <br /> r--- �. C 1 ` J lj+J� <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br /> ` 1 <br />