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PERMIT APPLICATION <br /> BUILDING / MECHANICAL I PLUMBING /SIGN / SPRINKLER i DEMOLITION <br /> No a CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everottwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1 48 1 5 t2544% P L SS PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:. ohv '6r eld TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> 15315 /'1�" ' PL t �/y (� }^y <br /> CITY 4.-ar s.+7`4'++'V E STATE W4 ZIP i 2 2 o k .. <br /> OWNER PHONE: L2..S 557 So Li t OWNER EMAIL: <br /> CONTRACTOR NAME; CM 1{{ 4 p .y�,r1 <br /> t✓ t t <br /> CONTRACTOR ADDRESS: STREET 1q1 ''ya �wy{w� <br /> CITY ` ' zel STATE A. ZIP <br /> 411 yZo <br /> I <br /> CONTRACTOR PHONE: 5 5C 05-50 CONTRACTOR EMAIL: doable, !' Gy1Vletlt1't • to <br /> l <br /> CONTRACTOR LICENSE#(REQUIRED): C tactr\,' lidn <br /> CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): I(.Pt1"'(2i <br /> PRIMARY CONTACT: 0 OWNER V CONTRACTOR Cl OTHER(Please Specify) .._ <br /> CONTACT NAME: iCONTACT PHONE: Las ,asci 0:::: ---c)'7‘f24:141-4-)' <br /> � <br /> }'.!2, .J CONTACT EMAIL: deb r l'e D Y e_ '-jrt .to t el <br /> a <br /> BUILDING PERMIT APPLICATION <br /> Existirr Use of tButtdink.: Contract Price of Work:$ i00 0 0 <br /> Proposed Use of Buildln : Heat Source: ❑Gas lectrlc DOther <br /> Building Type SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units DCommercial ❑Industrial <br /> Typo of Project: ❑New DAddition DRemodel DRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: i ns-tr ll C1.0G--1&ss heat vi& . <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> - <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn /Alteration Repair Type of Project: New _Addn _Alteration Repair <br /> #of . #of <br /> Fixtures List of Fixtures Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures <br /> NC—Air Handling Units 1 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 /> Chemical or Water <br /> I. No. of Heads <br /> ACKNOWLEDGEMENT:1 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.l am the owner,or i am authorized by the owner of this property to perform(he work for which application is made, <br /> and I comply with the Stale Contractors Law 18.27 RCW and 296.200A WAC. <br /> Oily of Everett Official Use Only <br /> PERMIT <br /> Petb '' ihtLws <br /> 'Owne /Authorized Agen ignature Date (Revised 9/23/2016) <br />