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griPERMIT APPLICATION <br /> BUILDING I MECHANICAL/ PLUMBING/SIGN/SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES f <br /> 3200 CEDAR STREET,EVERETT,WA 98201 j t b'/r <br /> '' ( "-0 2 i <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue--4r Black,inkOnly Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 2,o2. w( 0 1 p PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ... :: CONTACT.INFORMATION ;. <br /> OWNER NAME: {�Z is 0 t Q-)C 6t, C-u;w..i ttc)TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Fact D., st41/43 iirAt,3 LA <br /> CITY eru- ir STATE U 4 ZIP c 3 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: k A L)e l- CO N HT1 <br /> CONTRACTOR ADDRESS: STREET 4-170 i (;v e-4,` 6 l i t Ik L N +�(:-?-,. <br /> CITY 6:71) STATE b..)A. ZIP / 263 <br /> CONTRACTOR PHONE: 4/ZS—--•3443-1 0"5 S CONTRACTOR EMAIL: i h cu' Se,nc i C 10 v 4. C(.l ton <br /> CONTRACTOR LICENSE#(REQUIRED): C,b 1 -5!1 0l9S CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 055/O5 <br /> PRIMARY CONTACT: ❑OWNER lig CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: t;e® ) Alo .0 ki CONTACT PHONE: Li 2 S 3 3 ._ `lC> i <br /> CONTACT EMAIL: 2„16LAs et c0 }CIG Q8.COM <br /> BULL DING`TrPERMIT APPLICATION„ <br /> Existing Use of Building: Contract Price of W. :$ th) / bd 0 <br /> Proposed Use of Building: Heat Source: ❑Gas • - : =ether <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> p Pf.t,J d u"-1. (r-,..Icilo(refa. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL,PERMIT APPLICATION " , <br /> „�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 1 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Ir-j Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater - Refrigeration .5 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 9 Sink(Service/Bar/Mop/etc.) Other: <br /> '`:SPRINKLER I 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 0, '-1 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 c- . rr.r the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> P MI <br /> Owner/Authorized Agent Signature Date (Revised 5/20/2016) <br />