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RMIT APPLICATION <br /> e/4/". -17 - BUILDIN ECHANIC A / PLUMBING /SIGN/SPRINKLER/ a ; ION <br /> ITY OF EVERETT PERMIT SERVICES G'/�/w I. <br /> ,.4117--14 ' 3200 CEDAR STREET,EVERETT,WA 98201 1 VN <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> -PROJECT SITE_INFORMAF-ION ! „j„ 4'y ! .y' ,*' <br /> PROJECT SITE ADDRESS: e s/1;cam 6 et PROPERTY TAX#: (3L( c c '0(.4).+0-0LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ,., m CONTACT INFORMATION . pt_, „ °`.b. ..r <br /> OWNER NAME: NA M ra Jk4 TENANT NA (If Commercial): <br /> OWNER MAILING ADDRESS: STREET iYr/VQA✓ 5t ' UI <br /> CITY V fl STATE V A ZIP 01 <br /> OWNER PHONE:'77O(..p 14---1,`„p ( `q.0 n OWNER EMAIL: V\,w\ <br /> CONTRACTOR NAME: CLUQ -ri (/� AD <br /> CONTRACTOR ADDRESS: STREET \ , '2</`' \s J tf ( �//� <br /> CITY I v ` STATE 1A)/` ZIP OLp2) <br /> CONTRACTOR PHONE:LJ2' .1 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): 3 g i`"''`'Y CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):O Lf 0 <br /> . � " ' ' ' <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER <br /> (Please Specify) <br /> COTACT NAME: CONTACT PHONE: ' j1 \. <br /> \ -Etk V 0P-- ,\(‘A--2 - <br /> CONTACT EMAIL: l <br /> „3 BUILDING,: RITAPFLiCA "1OIW `4E' d ,, ' , - <br /> Existing Use of Building: Contract Price of Work:$ 0 _ <br /> Proposed Use of Building: Heat Source: ❑Gas Xlectric ❑Other <br /> Building Type: ❑SFR-Detached FR-AttachedI ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: New DAddition <br /> ❑Remodel ❑Repair ❑T.I. OSign OSprinkler ODemolition ❑Change of Use <br /> DESCRIPTION dF WORK: <br /> SI <br /> .7A)le AA,CAA,(k.S s5V) -\ ( (r1/\ 0/.\-g- --71(A' 1 <br /> ASSOCIATEDBUILDING PERMIT#(if applicable): <br /> {'.MECHANICAL PERMIT APPLICATION , , ;,:k'',A,, , PLUMBING;,PERMIT APPLI-CATIOW11,: jf4 , qra <br /> Type of ProjectNew _ Addn _Alteration _Repair Type of Project: _New Addn _Alteration _Repair <br /> #ofList 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 /> ,I SPRINKLER/.S,UPPRESSION SY <br /> fSTEMS <br /> )Number 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.1 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 pate Contractors Law 18.27 RCW and 296.200A WAC. <br /> '\ City of Everett Official Use Only <br /> i <br /> = �� <br /> .. 1 l PERMIT tl,C6C I V9--, <br /> Owner!,uthorized Agent Signa ur= Date (Revised 10/12/2015) <br /> 1 <br /> / <br />