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I III PERMIT APPLICATIO <br /> C"UIL I NL RECEIANICAL/PLUM ING/SIGN INKLIE- / 1;EMOLITION <br /> 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 I www.everettwa.gov/permits <br /> (Blue or Mack Ink Only Please) PR•-JECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: a cA.3 i V3 f'9 W SO PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION T <br /> OWNER NAME: g P42 Fe.e.IY \—c-- TENANT NAME(If Commercial): KPI t - <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: ..M-Q At Mom m , <br /> CONTRACTOR ADDRESS: STREET c/.5-1 4, el c--- .1-- <br /> CITY c A g(d(141 STATE '� ZIP I/o a9 I , <br /> CONTRACTOR PHONE: ct°e ,...9_4.7) ,L,2_7 5--- CONTRACTOR EMAIL: i9' Q&(jfl/y) t eyit rAcYr. <br /> CONTRACTOR LICENSE#(REQUIRED): c - oN6 S(y, V(2 5?Pl1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 02,36— X27 - <br /> .2`2;7 -- <br /> 3 1�/�y CONTACT EMAIL: 06 T ciLeAPVYI 4Myv,,,AX • KY) <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of W',rk:$ 0 ci <br /> Proposed Use of Building: Heat Source: ['Gas • - <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ['Addition ❑Remodel ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Nem tot S QA Ne. 1 vJk,�Cce)- <br /> Q�avY,k- s titifv. <br /> -� C6 - 10 0.5"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 /> mai Gas Piping a ti's 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 —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 /> Lr----m `gL0 -, � 0R ' <br /> Owner/Authorized Agent Signature Date (Revised 9/23/ano) <br />