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PERMIT APPLICATIOCi. <br /> 000.11. BUILDINCECHANICAL/ PLUMBING /SIGN I URINKLER/ DEMOLITION <br /> ,+ � CITY OF EVERETT PERMIT SERVICES <br /> �,M 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blase or Black Ink OnlyPlease) PROJECT SITE INFORMATION Q <br /> PROJECT SITE ADDRESS: 8807 07 Go/?BTh) PR. ale-f E Ty q 2 2-0 4' PROPERTY TAX#: �@©<j l-3 0©2.D d 2 O v <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ICONTACT INFORMATION <br /> OWNER NAME:N�PY Si, Utt> TENANT NAME(If Commercial): <br /> `OWNER MAILING ADDRESS: STREET P&©7 CoR.Bot) _DIZ <br /> CnY C.-yytr62-(:Ti STATE i' i 1 ZIP 6/C Z 0 V <br /> jr.. -"\IER PHONE: 25-6 6.`f.S-'I6a3 (OWNER EMAIL: { Y:iniPCS'7-2-4/1/t-Z-C3 4-/Y071/-.�-•0'`t/ <br /> ,'i' RACTOR NAME: . . <br /> ',,8TRACTOR ADDRESS: STREET <br /> CITY STATE ZIP 0.R <br /> 'P,..1TOR PHONE: CONTRACTOR EMAIL: <br /> R' '_TOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> ':,'W...-1 :INTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) •A, <br /> C n AME: CONTACT PHONE: 24-6-64 4---i.t'og3 <br /> '.-'` H fti R $jg ott CONTACT EMAIL: H0TNw.c 6z- Q "torc_ 0t -y 0 <br /> -- BUILDING PERMIT APPLICATION <br /> ,--Use of Building: Contract Price of Work: $ - �- _.. <br /> OWN 177k',,' <br /> ic,s, Use of Building: Heat Source: ❑Gas ❑Electric DOther <br /> ;, ;CN111,T.a,L SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> '' 41.1 6?roe.Qi.: ;ONew ❑Addition Q(Remodel CI Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> • rBT Oi OF WORK°CnA I/-Cie( Fit/LuZL`/ 1 Q Q 2j ro 3E-DR R OO/-7 <br /> (ONTR " . <br /> 0I3CTt BUILDING PERMIT#(if applicable): <br /> 'P-RiattettlimicAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> „ ,s•hProie04 _New Addn _Alteration _-••air Type of Project: _New _Addn _Alteration _Repair <br /> r #of #of #of #of <br /> List of Fixtures 1st of Fixtures List of Fixtures List of F res <br /> i,Tures Fixtures Fixtures Fixtures I <br /> k•- -- ^'P/C-Air Handling Units Heat Pump Toilet Backflow' venter(insi• • r -•; <br /> ri <br /> _.... ..Forced-Air.Systems Unit Heater Bathtub Urin . <br /> Dostitict ..Gas Piping Boiler Lavatory(Wash Basin) nking Fountain <br /> " - Water Heater Refrigeration Shower _ Floor Drain a <br /> ' ''-':L!" Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap ------- <br /> “u! 'Ir'c, Gas Range Ducting Dishwasher Roof Drains <br /> T , r,;r Clothes D • Hookups Other: Clothes Washer Medical Gas - <br /> ==„i <br /> nr---.rp_ Rate god 0 Water Heater Other: —'-- <br /> :: : . <br /> Exha t Fan Sink(Servi ar/Mop/etc.) Other: <br /> S' INKLER/SUPPRESSION SYSTEM <br /> .St v' AGhemical or Water I INo.of Heads } <br /> tAACKNOW$p EMENT•l 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 frormthe— - <br /> &Aiding 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 :1r A. MIT# :E;,;, <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br /> 1r� rt <br />