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PLAPPLICAT O ;. <br /> BUIL® /MECH•NICAL I PLUMBING I SIGN.1 SPRINKLER I DEMOLITION <br /> ,/.1,1V',':::::' <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blaze orr .tack Ink Oily Please) Pi'OJISCT SITE INFORMATION <br /> PROJECT SITE ADDRESS: -1 30 I()1` 1 Cr. S6-- PROPERTY TAX it: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> Cl ;NTACT INFORMATI(.N <br /> - OWNER NAME: WUf L� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS:��' STREET�� �n!��� <br /> -3d to 7 '� _ : S <br /> CIT (, <br /> Y _.,A,/be. STATE /4/7L ZIP 5�Zei, <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <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: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 1"zU 00 , <br /> Proposed Use of Building: Heat Source: OGas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial L7 Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> ,aESCRIPTION OF WORK: � � <br /> Z9-� Cv <br /> ASSOCIATED BUILDING PERMIT#(if applicable): \A) I 1 ©el— 0 O'j <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 /> AIC—Air Handling Units 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 /> I Clothes Dryer Hookups Other: • Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> i Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLE'=: /SUPP."ESSI'oN SYSTEM <br /> Chemical or Water I No.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 /> / <br /> — /gp— i2&/ PER <br /> Owne uthorized Agent Signatu�_ Date (Revised <br /> 99/v "jl.t� 10 -00 <br /> /23/2016) <br />