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grr PERMIT APPLICATION <br /> BUILDING/MECHANICAL/ PLUMBING /SIGN/SPRINKLER/DEMOLITION <br /> CITY OFEVERETT PERMIT SERVICES ORIGINAL <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.evere a.gov/permits <br /> . a -, PROJECT SITE INFORMATION ,7, _y ,, „_ <br /> PROJECT SITE ADDRESS: 5/(1 _7 ((�_L �1/i J PROPERTY TAX#:/0-1 (j,/j/�O�/yy 0 <br /> LEGAL for new construction: Short�rJJPlat/subdivision J J(�/I Lot No. (J(J (attach copy offllong llleegal(d/esscription) <br /> CONTACT INFORMATION,, r <br /> OWNER NAME: l7 id a%V 15 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET �, 71-I of ,S X) <br /> CITY E ri fi-- STATE C ,VVVJZIP(y745- <br /> _, <br /> OWNER PHONE: L/ 7*�lq` 5 p OWNER EMAIL: -- <br /> CONTRACTOR NAME: FJe. Fld .. <br /> CONTRACTOR ADDRESS: STREET i l l Cp 72 //St 9J) # I ? <br /> CITY / .0I Ct TSL'ilia <br /> ce STATE ZIP 9 1, ) <br /> CONTRACTOR PHONE: WO`11' '` /3 C CONTRACTOR EMAIL: ){� .../fej�ilkep ) teg <br /> CONTRACTOR LICENSE#(REQUIRED):Ews-Fpf-$ P CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)06- 9O_ <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CqyTACT NAME: CONTACT PHONE:Rogoge <br /> itr- 7lnC�l CONTACT EMAIL:� �h��L/�� »K <br /> /a� , (14-/,7-) <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 17,16a <br /> Proposed Use of Building: Heat Source: AGaslectric ❑Other <br /> Building Type: FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New -Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> f <br /> \-\\i't are Prr. -Piirriove giic( <br /> i"Lx1P (farip 1 / day. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): UAJf P ea I t l/I k1 i' j cit <br /> MECHANICAL PERMIT APPLICATION` PLUMBING PERMITAPPLICATION <br /> Type of Project: _New Addn _Alteration Repair Type of Project: _New Addn _Alteration _Repair <br /> #of #°f List of Fixtures List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC-Air Handling Units i Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler 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,I SUPPRESSION SYSTEM', -, <br /> INumber 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 lam 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 /> / egl1� P #�sod 02�-I <br /> .w el*, . :,•• -•p ,..-nt S • aturi Date (Revised 10/12/2015) <br />