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"Py%/-_ PERMIT APPLICATION <br /> BUILDING I MECHANICAL i PLUMBING I SIGN I SPRINKLER I 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 /> PROJECT <br /> jViAtIONAMeagtgannitaingteragagatag <br /> PROJE ITE'a R /o`0 7 y ,/ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> _.,._., e :CONTACT 1NFORMA'TION ...._�> ", .._ <br /> OWNER NAME: //t 2$$/�A7v.'r/ TENANT <br /> �NAME <br /> (If Commercial): <br /> OWNER MAILING ADDRESS: , STREET % 237 �^ 111 � �G'L`�- <br /> `STATE ZIP ?e Zb3 <br /> 2 <br /> OWNER PHONE: 92-5- Z60 r Y976 OWNER EMAIL: PatiL @4ll/Po a/Q Z / 7-- co2 <br /> CONTRACTOR NAME: Cte., i z <br /> CONTRACTOR ADDRESS; STREET /AZ, e2 ‘2136:71/49 <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAiL: <br /> CONTRACTOR LICENSE#(REQUIRED): CiTY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 1"I OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT N�AiNE: ����/�� f CONTACT EMAIL: U CONTACT PHONE: n���— Z.�0— �7� 7/1-'4964' <br /> �� <br /> �f /L l e <br /> r 5`` _... _.... _. S`'., ;.. BUILDING;PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Bui ng: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: FR-Detached ❑SFR-Attached ❑Duplex OMulti-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ONew OAddition ❑Remodel El Repair CIT.!. OSign OSprinkfer ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> e/ 74 ?O� �� � �•� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 7,2 <br /> I_.._.: MEGHANICAL"PERMJT APPLICATION , . N , _. d .:r PLUMBING PERMIiT_APPLi6ATION,__:_ _",':y_ <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 #°f 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'ISUPPRESSJONSYSTEM. ;."..., <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 I� <br /> current federal,state,and local law.The g-• •ng 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 authorize. nder•• -' • . lance.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 1 comply with th-Sta- .• 18.27 RC) and 296.200A WAC <br /> City of Everett Official Use Only <br /> •� ��` l// <br /> Z7 /9 PERMIT IV <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />