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Imo► PERMIT APPLICATION <br /> BUILDIN JECHANICAL/ PLUMBING /SIGN 'RINKLER/ DEMOLITION <br /> `,r CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 3 RDit - / si r PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> • <br /> CONTACT INFORMATION <br /> OWNER NAME: ffreVe1f G(14IG TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3101 thri <br /> (fQV`Q it CITY CITY STATE ZIP 9S 20 / <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: U4)1 Je3S(I`e /4E-cri heA(, Coni eAcro J _2,--,47 c. <br /> CONTRACTOR ADDRESS: STREET ig6// %f lit Pt% Weil <br /> CITY 440K/L Ma STATE W 4/ ZIP 7g 2:7S <br /> CONTRACTOR PHONE: 20 6•36 y ,1'/o CONTRACTOR EMAIL: /-.f'fevt LL @ 0144c, • tool <br /> CONTRACTOR LICENSE#(REQUIRED): <br /> .._....._. . . SE#(REQUIRED): 0 0 6 2 6 <br /> up�luf✓'1f /v q CITY OF EVERETT BUSINESS LICENSE - . <br /> PRIMARY CONTACT: 0 OWNER r pg CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2)6 6 cl1 Y/s7 <br /> c ff-i? (5 K€V v\1 CONTACT EMAIL: C KeYIh y& Z1 W(c f . Com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ $ .2-6.-00. <br /> Proposed Use of Building: Heat Source: ❑Gas 0 Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex DMulti-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel El Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: (n S1`/ o� Q/h4K /, s(t 1( A V�/DJ <br /> V l <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 #°f 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 I. 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 /> 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 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 /> PERMIT# <br /> y00./6 1) i (°014 —D ( <br /> Ow er/Authorized Agent Si nature Date (Revised 10/12/2015) <br />