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PERMIT APPLICATI�I II <br /> BUILDI —MECHANICAL/ PLUMBING /SIGNRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or-Black Ink Only Please) r PROJECT SITE.INFORMATION _. <br /> PROJECT SITE ADDRESS: iL/a26 L.,M bet ill Ak. i'tiercftVet q1 e.2bl PROPERTY TAX#: 0175 ij g c, -®o <br /> LEGAL for new construction: Short Plat/subdivision WC ISI D t0 AO Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION .. <br /> OWNER NAME: aryj'CL k P/LGA, I TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /'/zis 6 Lo iW5 <br /> it.crt1- CITY STATE Wit ZIP q9 1 <br /> f ] �^ CO OWNER EMAIL <br /> OWNER PHONE: f �a�.7 ....:.J �..:.. �a��l� .. .,.. . <br /> -fiCOCONTRACTOR NAME: 6110e/er bo 4-1- <br /> CONTRACTOR <br /> NTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: PtI OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:. 0eS(gN U% CONTACT PHONE: ii25-5)$-3/„2.‘ yK.y'ix-Ark �2 <br /> I /y�ai,L I P11-6'ta' f 4jfIv 5,4 i-pa-ij , CONTACT EMAIL: <br /> ._ 1 BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Wo $ WC <br /> Proposed Use of Building: Ga!`Rr Heat Source: OGas ik -. -'_- - er A/®N°e <br /> Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: giNew DAddition CI Remodel 1:1" it ❑T.I. DSign El Sprinkler ❑Demolition CI Change of Use <br /> DESCRIFTION OF WORK: <br /> 3 0_ lit iii )44,3v GRrd fe <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 o)`Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures 1 Fixtures <br /> NC–Air Handling Units Heat Pump Toilet ; Backflow Preventer(Inside Bldg) <br /> Forced Air Systes Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) D 'nking Fountain <br /> rfcs <br /> Water Heater Refrigeration Shower 1 loor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> _ Gas Range Ducting Dishwasher I Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washgr Medical Gas <br /> Range Hood Water Heater I Other: <br /> Exhaust Fan Sink(Service/ear/Mop/etc.) Other: <br /> i <br /> SPRINKLER I SUPPRESSION SYSTEM' <br /> .._.....„SPRINKLER INumber of Heads_ .._. .. 1 <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.lam 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 /> —`' ,;2' 'r/ P s # 6 — •• <br /> CO <br /> Owner/Authorized Agent Signature ate/ (Revised 5/20/2016) <br /> , 00 <br /> �i <br />