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PERMIT APPLICATION <br /> BUILDIN( ECHANiCAL/PLUMBING /SIGN /UINKLER/ DEMOLITION <br /> Nitiai <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 2-'7 3 j 1 2 PROPERTY TAX#: 2 90 S-1•7O0103 2O <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: EVE Koos) IJ 6 (j 1-} , TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET -`�(C -3 Cot VI.,.... Ni cL <br /> Crr' v E e_E� STATE W ZIP 9 5 2_0 k <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: T' <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LiCENSEE/#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: NJ OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (--fz j 2_,Q13 - fro I S 1-trr ©,-J(„> <br /> ..may-rpt,j kArc_ '--i ►E. CONTACT EMAIL: dfc <br /> - i , k Q •e.ti/ , O.. <br /> BUILDING PERMIT APPLICATION j <br /> Existing Use of Building: "'Y(3.r-+rvi 1'5 Contract Price of Work:$ 10 <br /> Proposed Use of Building: Sfj-rvtel Heat Source: ❑Gas ❑Electric ID Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex I'Multi-Family-#of Units: q DCommercial ❑Industrial <br /> Type of Project: CI New DAddition ORemodel El Repair DT.I. ❑Sign DI Sprinkler CI Demolition CI Change of Use <br /> DESCRIPTION OF WORK: A- _ - • a <br /> PO AO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 2711 OBJ OL 3 <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 '.4 Toilet Backflow Preventer(inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler t-( Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove k..f Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting 4Dishwasher Roof Drains <br /> LI Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> LIRange Hood y 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 properly to perform the work for which application is made, <br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ..-..\E —_ <br /> IN <br /> PERMIT# <br /> y.,( -) a -v tg <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />