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417-5 PERMIT APPLICATION I <br /> BUILDINECHANICAL/ PLUMBING /SIGN i .SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 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 /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: - TAX#: <br /> /G1// 01 e4/ s+ <br /> LEGAL for new construction: Short Plat/subdivision Lot No._ (attach copy of long legal description) <br /> (reAV &k LQY\i-ety CONTACTINFORMATION <br /> RMATION <br /> NA <br /> 0WNERNr€:f /e.�' O-Z, Vr 1 6C/1""0/ (,11611.,F° 4liidtakfi N• I' (If Commercial): <br /> OWNER MAILING ADDRESS: STREET ':jZ,�J'�J-t_(.�(� lc. <br /> CITY �ll`�C,/ S LA) ZIP CA 10 <br /> OWNER PHONE: 7/ 9 5/-/L OWNER EMAIL:ahc 9?C,/5-f�` � ._, c2 ''" <br /> _ - , �✓ <br /> ('ONTRA 1 I ADDR SC: STREET e- • 71r- <br /> if CITY - -'T STATE^ jCT._ ZIP -'�-- �_ <br /> CONTRACTOR PHONE: - 7, - —"r' CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): — '� .."7-:'' ", 1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRE c : 094(19-6-„_. <br /> PRIMARY CONTACT:"$OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: "7/CI_((3/._..j z7c ”' <br /> I / - l % CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 3;,,,,.j 1 ca :(ti (-AG> Contract Price of Work:$ /11 7,56 <br /> Proposed Use of Building: Heat Source: ❑Gas Electric DOther <br /> Building Type: ❑SFR-Detached DSFR-Attached ❑Duplex DMulti-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: ❑New DAddition La Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:A 1-.) i tic, ezovd► L.0,4 01", S� <br /> -"" <br /> (LArtil ,jsio of Esq <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 List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <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 Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number 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 Co.:•-otprs Law 18.27 RCW and 296.200A WAC. <br /> / City of Everett Official Use Only <br /> ..( fiJ�`6 PERMIT# 1j l f„CDak <br /> Ow . Authorized .gent Signature Date (Revised 10/12/2015) <br />