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PERMIT APPLICATION , g <br /> BUILDINt MECHANICAL/PLUMBING /SIGN / INKLER/ DEMOLITION <br /> ° CITY OF EVERETT PERMIT SERVICES <br /> i� 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,-) 3 ' I a' S PROPERTY TAX#: Z 9a S-1700103 201) <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: VE fi[f VS (-s ri-I,t 4 , TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET -`3(0-3 Co( \43, 1, i <br /> cnY _v E_E IT STATE ‘A.14- ZIP 49 5 G_S/i <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: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: C12:5"-- 2' 3 -, So I 'Z) TEXT- ©P Ly <br /> '4c -&D5 k.\-e-,__ 4---o..) CONTACT EMAIL: ,f— , in Q_ ,ems , ,5, <br /> BUILDING PERMIT APPLICATION r� <br /> Existing Use of Building: ` "i> 4-(try.��-i f r Contract Price of Work:$•S-OO$ 1(8 ,1c)O <br /> Proposed Use of Building: Sft-rviE Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex L7Multi-Family#of Units: q El Commercial ❑Industrial <br /> Type of Project: El New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition El Change of Use <br /> DESCRIPTION OF WORK: /I <br /> c ess b� it r- �,-irnr�•r , �G/\�� 'ip„ �.. '� <br /> ifr. <br /> LT 9 r`��-{s �,, tM,xs 1 ports 3, <br /> ASSOCIATED BUILDING PERMIT#(if applicable): •0✓ 4 '1''"C," ,6 f 6 J.4-1 6 r <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_ Addn _Alteration Repair Type of Project: _New Addn Alteration _Repair <br /> Fixtures List of Fixtures Fixtures list of Fixtures #of List of Fixtures #of List of Fixtures <br /> 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 /> Ov�- �- PER�liOS- 659) <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />