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PERMIT APPLICATION-- <br /> ' BUILDIN IECHANICAL/PLUMBING /SIGN / U R.INKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> NI/gig' 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: 2-`* ( 2 tea' 7 PROPERTY TAX#: Z 9O S-1700 103 20 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: tom,.VEIZer V:YotaS) 40 L €)l ` l- , TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3 f 6-7 CQt � �L <br /> cm, �v G_�E STATE Wil - ZIP 9 5 Gam' <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: T <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: grOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: CfZ j- 2,"3 , ` TEXT- ppC> <br /> 40-r� {� t LLTdL)c CONTACT EMAIL: ,f•- X41 � k cs .e._,/ x,it. . 6- <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: "'Y n-r-+M e.! '}S Contract Price of Work:$ V— . <br /> Proposed Use of Building: SPs-rule. Heat Source: UGas ❑Electric ❑Other <br /> Building Type: DSFR-Detached DSFR-Attached ❑Duplex L'+'tMulti-Family-#of Units: q ❑Commercial Dlndustrial <br /> Type of Project: ❑New ❑Addition ❑Remodel El Repair DT.I. El Sign ❑Sprinkler CI Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> A <br /> fir fi ACS `^' dc `�` <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 'I'(o6-•O b <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 I-( Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater _ Bathtub Urinal <br /> Gas Piping Boiler y 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 /> y Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> yRange 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 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 /> k---\E -- PERMIT <br /> illg <br /> em— 3- «(o-al 3 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2 16) <br /> Z <br />