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\/ii\lir PE*MIT APPLICATI= <br /> BUILDING/ 1.MECHANICAL/ PLUM i:ING /SIGN/ SPRINKLER 11EIVIOLMON <br /> CITY OF EVERETT PERMIT SERVICES <br /> VT 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> ,.(ae or ;lack Ink Only •lase) 'I-OJECT SITE INFO••MATIO <br /> PROJECT SITE ADDRESS: 7, 7)- l (. /4,, ✓C' PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision / Lot No. (attach copy of long legal description) <br /> C..'NTACT INPORMATIi•�N <br /> OWNER NAME: /C o / ;,,k 0�, /(05 71c//, TENANT NAME(If Commercial): Patio/0 J z , <br /> OWNER MAILING ADDRESS: STREET 2 �./L,1 <br /> 60/6/,,, J t"y <br /> /J�lJ�i�L�./ _ — CITY STATE 6 <br /> ZIP , 63 2.G21 <br /> OWNER PHONE: ! Z j9��-_ 7-3 7 _e, G 2 S OWNER EMAIL: 2 / r <br /> CONTRACTOR NAME: 7 , '/9 oC /S- '-< P r,/ f.` �`` S(-d"7 C c 1`!OC. <br /> 4 , £ G <br /> CONTRACTOR ADDRESS: STREET 5 l c' // 2_ 3 " ci g"rv_ 3, <br /> cry e_! ./,z/e- STATE 1, ZIP 1 `v" 53 <br /> CONTRACTOR PHONE: 'C)G ,b J 3- f 6 ?- CONTRACTOR EMAIL: 7�i�1r> cl,�,�.�'d <br /> v a C�7'/`a`Te el ..Am G'.,(.G-cera _ <br /> CONTRACTOR LICENSE#(REQUIRED):1-472/11/43/4/1%-5.5'3416 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 5ie1 O <br /> PRIMARY CONTACT: ❑OWNER Li-CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:,,�]j CONTACT PHONE: Z a C- c' j .S7(.9C.c�`i L✓ d •O/" 168 is CONTACT EMAIL: . <br /> j"C;/rood`,�t,,2, 74re04if c,,l•ccc4. <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ // J O c2 <br /> Proposed Use of Building: Heat Source: 2Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: EC nmercial ❑Industrial <br /> Type of Project: :New ❑Addition DRemodel ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: -- j /� / <br /> 1 s15`,7 e1 4 A 6,v . )re Ai/f ra s S ICA S �"'��r•� /Of- d/f- C1 4,/ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): A f 1 04-6153 <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 /> Chemical)r Water 1 7/ 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 /> al <br /> Owner/Authorized Agent Signature Date (Revised•/3/2016) <br />