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IIIIIII�IPERMIT APPLICATION <br /> /1111P1*.ZI":"'A BUILDING? ECHANICAL/ PLUMBING /SIGN/J INKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 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 9-14i 6.G /d i!� � PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:A- V Ao 3/4., /,,. TENANT NAME(If Commercial): /2om,'a t5 / ,` 2 <br /> OWNER MAILING ADDRESS: STREET //3 3 / 2 2 n �� ��. SLe" <br /> CITY �\/Z,„et,e, �/ STATE w4 ZIP 7 L O G6 <br /> OWNER PHONE: 17'2 5 �- 3 ? ` d / 5 OJWNER EMAIL: <br /> CONTRACTOR NAME: 7 l /`'/O , s -P, /- i cc t e/c C7' 2 <br /> CONTRACTOR ADDRESS: STREET S '6( 2$r/,Q ,e <br /> CITY 4- 3e Q 711/e STATE a1,9 ZIP /'eSS l6 g <br /> CONTRACTOR PHONE: Z pc-3— 5—/ CONTRACTOR EMAIL: 77:1/9,4 00 iy-a t,�✓�j/� ,m • <br /> CONTRACTOR LICENSE#(REQUIRED): Y41 //6 R183(1 C, CITY OF EVERETT BUSINESS LICENSE#(RE e. RED):alp <br /> r (t`eL <br /> PRIMARY CONTACT: 0 OWNER $CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT <br /> T NAME: CONTACT PHONE: G �j ,j 57,9 <br /> 3-- 5 <br /> CS C 72-041J 70 (3/')- 1-4 r� CONTACT EMAIL: Wh 00 el d ri f e 7, ql C dJV? <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ el C, a© <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric //❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: 1deommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> sal/ Z fyie / /nQ�l/s exI�6))-/ /A G..� --/emieete tw/ce �p 4)1r <br /> for C oerorefC2J ( <br /> c C®•IG4Csi 1 Q5 <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 /> 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 /> Z Range Hood Water Heater Other: <br /> 2 Exhaust Fan Sink(Service/Bar/Mop/etc.) - Other: <br /> f Crig ke <br /> SPRINKLER/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 Contract' s Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> J,, PEP <br /> Owner/Aut oriied Agent Signature Date (Revised 9/23/2016) <br />