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PERMIT APPLICATIO II II <br /> BUILDIECHANICAL/ PLUMBING /SIGNI'RINKLER/ DEMOLITION <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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: /A660 101114 A\A' Gam PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (� t..C.6 (- j�-t((� (6,6. TENANT NAME(If Commercial): pp'E4 � tAlg <br /> ME47( AL C 'G17-1G--� <br /> OWNER MAILING ADDRESS: STREET -e:•L�-msets, �X e9.2:•11.2. <br /> CITY J STATE �WS ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: f.,( ,W(_,,AW rJ Grsi-46 LIC-na?1/4l GD f (t•-4 . <br /> CONTRACTOR ADDRESS: STREET 107,O0 G1-46&f'f-IUT *1iZ 1 `,' <br /> CITY E`4 E17.-. � ` d r STATE WAS 4:023,4:023,ZIP 2,6 <br /> CONTRACTOR PHONE: 42) • 2 '- • • -.• TOR EMAIL: {'1'ak k'Gd 1'(ewIannct s m <br /> CONTRACTOR LICENSE#(REQU ' D): K.cloukc,4931.(3 ri CITY OF EVERETT BUSINESS LICENSE#(REQUI D): 8 D CO <br /> PRIMARY CONTACT: 0 OWNER ■ • 4e •- ►_ •THER(Please Specify) Ai2 {-411"Ff�'T' <br /> CONTACT NAME: CONTACT PHONE: .4.2GJ. Cjg,623 <br /> -1:›m!t't--/ CONTACT EMAIL: (oma -G e-csgr2 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 4,:str ia'IGr"ltA( � Contract Price of Work:$ ' lloe',C3Z)0. DD <br /> Proposed Use of Building: Heat Source: %Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family #of Units: Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition X2emodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> M t f--(rs{2- -CZE M t E V.X1-erlr-taT V A -f.1- -r-Ir✓-t 1-c- - mss <br /> ou A'TT * t- LA AC-G <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 Lis ixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC-Air Handling Units Heat Pump Toilet Back • Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub al <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 %okups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heate Other: <br /> Exhaust F. Sink(Se. ce/Bar/Mop/etc.) Other: <br /> SPRI LER'/-SUPPRESSION SYSTEM <br /> Chemical or Water 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 /> P IT# <br /> ZDZ. - 65 <br /> Owner/Authorized A ent Signature Date (Revised 9/23/2016) <br />