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PERMIT APPLICATION <br /> BUILDING 1 MECHANICAL/PLUMBING I SIGN I SPRINKLER/DEMOLITION - <br /> . CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov j www.everettwa.govJpermits . <br /> (bfae.®r laIack Ink Only Please) . - PROJECT SITE INFOI IlllMlle& • , <br /> PROJECT SITE ADDRESS: 5 Glp S.S. avatar mi6.414.041 )PROPERTY TAX#: z8a 61 etjv "5'dpa I <br /> LEGAL for new construction: Short Plat/subdivision of No. (attach copy of long legal description) <br /> .CoNtACT IEdP®R➢IIATI®Id . . . - . .- • - . . . <br /> OWNER NAME: "LCL EAL eil l..I uwt, . 1 TENANT NAME(If Commercial): ; <br /> OWNER MAILING ADDRESS: STREET 'Zp 512Lcitts <br /> crrY °A(L) STATE/ D/V" ZIP L 8 3 j=2_, <br /> OWNER PHONE: V(7- 212.- 112$ OWNER EMAIL: 4/Y5I(), kD e cm, .a4 <br /> CONTRACTOR NAME,,,. EU .0 AJ.....,.-.6tfi C-(-( 4 T�ffE ' TA- ,...,:....._... :................. .......-. ,.. .. , <br /> CONTRACTOR ADDRESS: STREET 'I�0 (� t Auer <br /> CITY F.a2V STATE (Al.0,— ZIP e:320/ <br /> CONTRACTOR PHONE: 4°2-5,12-c 2.-`5((c.f • CONTRACTOR EMAIL: AO e ..sfMLOa .GOvvE <br /> CONTRACTOR LICENSE#(REQUIRED): EVQ26,5S 02,`�0 r CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): La(,i at c5- <br /> PRIMARY CONTACT: 0 OWNER IRCONTRACTOR 0 OTHER(Please Specify) - <br /> CONTACT NAME: CONTACT PHONE: 4 Z 5-S5'2"'5/19 <br /> M A �>ON 6 CONTACT EMAIL: M, 4 @�WA . ern-, <br /> 11 Existing Use of Building: OKAt I Contract Price of Work:$ 5 3 v`S <br /> Proposed Use of Building: 0 Heat Source: Was DElectric ❑Other <br /> p g C.� <br /> Building Type: ❑SFR Detached CISFR Attached l�Duplex ©Mufti Family-#of Units: ' (Commercial ❑lndustrial <br /> Type of Project: ❑New ❑Addition I:RemodelRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition DChange of Use <br /> DESCRIPTION OF WORK: rzatcoE Z Qc4At,� R `5 DN 53(, A- A it u&ri-S L.04 coif-Li K6 <br /> 604/4.e. 119t ktto.J , 51 ,�,Af4U'1( i Wlt~(ANT l <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> . <br /> MECHANICAL PERMIT APPLICATION 1 . • . PLUMBING PERMIT APPLICATION ' <br /> 'Type of Project: _New Addn _Alteration Repair Type of Project: New Addn Alteration Repair I <br /> #of List of Fixtures #°f 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 /> ' '. . . SPRiNXL.ER/SUPPREppION SYSTEM , <br /> (Number of Heads <br /> ACKNOWLEDGEMENT:l 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./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 18.27RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> S j a <br /> (. tilt <br /> 1 <br /> IPERMoO�� <br /> Oar xrfAuthorized t Signature Date (Revised 5 20/2016) <br /> I <br />