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IIII''IIII I!'�PERMIT APPLICA <br /> BUILDIRG/MECHANICAL I PLUMBING/SN/SPRINKLER/DEMOLITION <br /> MN <br /> efil%)/PIP.0. <br /> ��/''�_ CITY OF EVERETT PERMIT SERVICES <br /> ' 3200 CEDAR STREET,EVERETT,WA 98201 <br /> • <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits , <br /> (Shia OiVatek.Ink OnlY Phase) PROJECT SITE INFORMATION 'oyr2p t Yir,i l <br /> PROJECT SITE ADDRESS: (9//q /914 5' L I _. PROPERTY TAX#:,r't5A/-3 y/3 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:( J"Y la, C,(k,,5$ TENANT NAME(If Commercial): 3�c f'' P <br /> OWNER MAILING ADDRESS: sTRsETX A J, //4. st- <br /> j d�" <br /> CRY- f�.Q _ STATE ZIP <br /> OWNER PHONE:r Li?_ A 5,2 ()—3 96, OWNER EMAIL: 044 p Cp- e7-z , <br /> CONTRACTOR NAME: 064,42 -- <br /> CONTRACTOR ADDRESS: STREET , <br /> CRY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 046WNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: r 7/3- 172 <br /> MO-- 4/lad CONTACT EMAIL: <br /> BUILDING.PERMIT APPUCAT1ON <br /> Existing Use of Building: Contract Price of Work* <br /> Proposed Use of Building: Heat Source: as ❑Electric ❑Other <br /> Building Type: ❑SFRched OSFR-Attached ❑Duplex ❑Multi-Family-#of Units: OCommercial ❑Industrial <br /> Type of Project: l if ew DAddition DRemodel DRepair OT.I. ❑Sign DSprinkler ❑Demolition DChange of Use <br /> DESCRIPTION OF WORK: <br /> Gt,c1 v I <br /> ,)\--AANthA/r <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHAIII AL PERMIT APPLICATION" PLUMBING PERMIT APPLICATION <br /> T of-Pro Addn Alteration Repair of-Project: V New _ Type of Pro,Iect. New' Addn Alteration" �Repair <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Rxtures Fixtures Fixtures Rxtures <br /> A/C—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 I Water Heater Other:Gec p j PQ., <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other. <br /> SPRINKLER/,SUPPRESSION SYSTEM <br /> Chemical or Water I INo.of Heads <br /> ACKNOWLEDGEMENT.•I have reviewed this application and confirm the information contained herein is hue 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.1 am the owner,or/am authorized by the owner of this property to perform the work for which application is made <br /> and t comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> (' I ' / 1__, il-- A'- ,- `7 PERMI 1r ' 04) <br /> Owner/Authoriz-. Agent Signature Date (Revised 9/23/2016) <br /> 4v9/�23312016) <br />