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OLT PERMIT APPLICATION: <br /> BUILDINu i wIIECHANICAL/ PLUMBING /SIGN tbl'RINKLER/ DEMOLITION <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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: t SZ 3 f 2-i of St St- - 6 i PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: •j f'-j i f Y /l47j 5 Ey-E TENANT NAME(If Commercial): --j j4( 7 j- / /-, <br /> OWNER MAILING ADDRESS: STREET (S-2 1 52_1„...,A ct g•- i I � -r� (,(•l- <br /> , 63(-26-6 <br /> CITY STATE ZIP <br /> / <br /> OWNER PHONE: G 2,6 - 2b f 3 3" ( 3 OWNER EMAIL: <br /> CONTRACTOR NAME: AA (XJ S Are-.0/0 SOilJ <br /> CONTRACTOR ADDRESS: STREET 47j2- [, ( 0 6 7t gr 4:-. C ' / p <br /> CITY f [ 7, - STATE I i ) ZIP �l�Z.af <br /> CONTRACTOR PHONE: 4 7S--�')•O�24 / CONTRACTOR EMAIL: /> t /eVVg_c,/� L6 ® ( • ca <br /> yit <br /> CONTRACTOR LICENSE#(REQUIRED): /t ( IS S 0033C- CITY OF EVERETTTTBUSINESSVLICENSE#(REQUIRED): '153 <br /> PRIMARY CONTACT: ❑OWNER tiCCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: /1 ( � j --L ti p CONTACT PHONE: 6--7'iI .- 4-6-0-6 <br /> I l Q` CONTACT EMAIL: ki `_ci)L.(9-,q 6 I4 cs/T(h <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ 27b' <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: DSFR-Detached USER-Attached DDuplex ❑Multi-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: ❑New EAddition DRemodel ❑Repair ❑T.I. 1Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Pv- fpr-GL o c74A) v AiT 61,P‘yP <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 /> A/C-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 /> 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/SUPPRESSION 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/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 /> PERMIT o /H 1 !n Q <br /> — Ul 1 vI` VOwneit.j"--... .______6„.____9.____ <br /> orized Agent Signature D to (Revised 9/23/2016) <br /> (11/ <br />