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PERMIT APPLICATION <br /> BUILDINC#IIIECHANICAL/ PLUMBING/SIGN !�INKLER/ DEMOLITION <br /> '1911PAI`# CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: Z 7 0S- 12Th' S l PROPERTY TAX#: Z 90 S'1700103 2O0 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: iT VE Mtn.) (pc., (J n-i-V , TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3(c5`7 C©t kl� !'TLi nc:- <br /> cnY �E-V_4 r STATE ./ ZIP 9 g 2_0 k <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: -1--R <br /> CONTRACTOR ADDRESS: STREET <br /> Crrr STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: iRrOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (i2-5- 2-T3 1 S '-- OP,iLY <br /> Y-1.,-D5 kcL_1'_ €. CONTACT EMAIL: ,f-pllv✓co k'\ Q_ .�V k v , 6,r-,r? <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: A-4)13_4-4 rvi x-E '}S Contract Price of Work:$ J g {$j 7 OU <br /> Proposed Use of Building: SPrro€ Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ET/Multi-Family-it of Units: q ❑Commercial ❑Industrial <br /> Type of Project: El New DAddition Remodel ❑Repair CIT.'. El Sign ❑Sprinkler CI Demolition El Change of Use <br /> DESCRIPTION OF WORK: C7'r-, ` Z)C kip.-j p „P ,INC)V P[4 I ci>.— <br /> Ther/ ,so.._..__,y A n' I 4...i <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 /> 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/SUPPRESSION SYSTEM <br /> Chemical or Water I 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 /> ..-..\E <br /> a 3— PERMI /#�� o'5 D <br /> Owner/Authorized Agent Signature Date (Revised /23/2016) ���/// (....6) <br />