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PERMIT APPLICATIO— <br /> BUILDINC—IECHANICAL/ PLUMBING /SIGN 'RINKLER/ DEMOLITION <br /> I�'►;-"A 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 Iwww.everettwa.gov/permits <br /> (Blue Black Ink Only Please) PROJECT:SITE INFORMATION': ; <br /> PROJECT SITE ADDRESS: 504 56.11 l/ " 'E &7T .00) PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT'INFORMATION <br /> OWNER NAME: 2es. s,t - 'J 2v/C TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 5,63O /� altil <br /> StvzQt (Jy�/I`¢'7�"_ j"-' / 7 <br /> CITY L /Yv W CC/D STATE W k ZIP FSiT <br /> ,_?,6 <br /> OWNER PHONE: 42c 64 ' —2/el OWNER EMAIL: ZORf}V)eiV€2 1/(C'020,11-CA per <br /> CONTRACTOR NAME: OI(/ E-k <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: II OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 225 �7 p -2/aa') <br /> �4RAN 7'1e2 -U/C CONTACT EMAIL: 2.pjerplc Q tikic4g7 7 <br /> • BUILDING'PERMIT`APPLICATION <br /> Existing Use of Building: Re1H7 -i- Contract Price of Work:$ $ 4 55. OO© <br /> Proposed Use of Building: 5rg, Heat Source: ❑Gas CKElectric ❑Other <br /> Building Type: ®SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ®Remodel ❑Repair ❑T.I. ❑Sign El Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> CAM1.161 IsD, b))--"/ucitK L 3 I c,'&1147 1 N )0tEE/,c bels . C.>91- )kt 67 5d aeit1 <br /> drub *K 7°Att , gEF/W t'SJ 7Wf az' Z-S., U .FRA A4 iv <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 of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump f Toilet Backflow Preventer(Inside BIdg) <br /> Forced Air Systems Unit Heater I( Bathtub Urinal <br /> Gas Piping Boiler 4 Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove 1 Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting 4 Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> 4 Range Hood Water Heater Other: <br /> 4 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 /> Xe°(e1-)4-e'L- PERMIT* <br /> ��/�� 201,6 C°-1 (00 (0 — bc3 <br /> Owner/Authorized Agent Signature 17 ate (Revised 5/20/2016) <br />