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PERMIT APPLICATION <br /> @LT BUILDING 1 MECHANICAL l PLUMBING /SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 88201 <br /> (P)425 257 8810 FAX 425-257-8857 I(E}everetteps@everettwa.gov I www,everettwa.govtpermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:1v5,24 , f PROPERTY TAX# IJt-Jl� t <br /> :bon 111 U <br /> LEGAL for new construction: Short Playsubdtvision `r-� <br /> ---• Lot No, (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:Wait- (�.o 5u,De .ems TENANT„ NAME(If Commercial): <br /> � <br /> OWNER MAILING ADDRESS: STREET `'p , `' aa� �t- <br /> ,.,��, CITY. 11a'e.` [[[////�GV���J�LLLL ����—�-� STATE �� Y <br /> iii <br /> OWNER PHONEa *t-t -""Ftr3 !OWNER EMAIL: L, <br /> CONTRACTOR NAME: 1/9-9-1 111J61n/--i ik i. aZ ic--/ i6 S <br /> CONTRACTOR ADDRESS: STREET 171S .. 1114,4-- 14 .v 56 _ P() c OX S/Gv D,�1 U <br /> cry p-erift1I1 t. <br /> vSTATE , ,r* ZIP l U��t' <br /> � <br /> CONTRACTOR PHONE: 26-- - (/g7/ !CONTRACTOR EMAIL: UJ/ -Wi' HV,9 cP6/14)41(.4 ow <br /> CONTRACTOR LICENSE#(REQUIRED): (i( * - L..?'q p e 'CITY OF EVERETT BUSINESS LICENSE#(REQUIRED}: <br /> 059W.ei <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACTcNAME• CONTACT PHONE: V2 3_C/ 7/ <br /> �J /OR PHONE: CONTACT EMAIL: LL�f}'k1,9-Hi.ii 7@ 6o ,.Of'k) <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: to ciaiituil Contract Price of Work:s, I SPU <br /> Proposed Use of Building: Heat Source: <br /> ❑Electric ❑Other <br /> Building Type: X0R-Detached ❑SFR-Attached ODuplex ❑Multi-F=114 of Units: 0Cammercial ❑lndu al <br /> Type of Project ONew OAddition ❑Remodel DRepair OT.I. DSign OS.rink ler °Demolition i7Chan.e of Us- IF 11 a, <br /> DESCRIPTION OF WORK: 1 <br /> / w1'&&2/ot.a r0 W p 'Alai/6e—)ie <br /> ASSOCIATED BUILDING PERMIT#(if apelicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION �� <br /> Type of Project: New Addn Alteration Repel Type of Project: <br /> / _ Re air ” ;!f <br /> #of New Addn Alteration _ p f... <br /> Fixtures List of Fixtures #of #of List of Fixtures #of <br /> Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures <br /> A/C-Air Handling Units " Heat Pump Toilet • Backflow Preventer(inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub <br /> Gas Piping Boller- <br /> Lavatory(Wash Basin) Drinking Fountain <br /> I Water Heater Refrigeration Shower <br /> Gas Fireplace • Wood Stove r Floor DrainT <br /> Gas Range Kitchen Sink&Disposal Grease Trap <br /> g Ducting Dishwasher Roof Drains • 4 <br /> ,Clothes Dryer Hookups Other: Clothes Washer <br /> Range HoodMedical Gas <br /> 'Water Heater Other; <br /> Exhaust Fan Sink(5erviae/Bar/Map/eta) Other: — <br /> • SPRINKLER I SUPPRESSION SYSTEM ' <br /> 'Number of Heads - <br /> ACKNOWLEDGEMENT.f 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 taw.The granting of a permit only authorizes annmvarf work anti rvo deuinirono Moraine'''.D=v;ptrw,a must Mai be autnonzeri in wiiling from the <br /> Fuit ia oma;oi berwe being aurnorrzed under any circumstance.I a he owner,or l am authorized by the owner of this property to perform tree work for which application is made, <br /> and t comply with the State Contractors Law 98.27 CW and z96.2 WAC. <br /> JLU �� �� City of Everett Ctficiat Use ony�j'f f � <br /> PERMIT# /�/� /�1 y�1 /'SI <br /> I1 V I 1 UJ (J"l <br /> Owner/ orized Agent Signature Gate <br /> (Revised 5/20I2096) <br />