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PERMIT APPLICATIOligh BUILDINOECHANICAL/ PLUMBING /SIGN RIP RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 410 W7 7 <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue ar back Ink Only Please) PROJECT SITE INFORMATIOIII&i"z '_:, , , . <br /> PROJECT SITE ADDRESS: 4/0)tp bW Evertair MAW.. WAN' PROPERTY TAX#: te011et OO I OO70O <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> cOI 'IAA NF ON x, < <br /> OWNER NAME: 114reoot4 NATL. I1J6U,I1Ad4CE. CO. TENANT NAME(If Commercial): UNION es04414 <br /> OWNER MAILING ADDRESS: STREET 501 ` 1�7�rt4 U4 ''3.4Th Fl... <br /> CITY Henry 'O ► STATE NI. ZIP 10038 <br /> OWNER PHONE: (tit) * "*.1500 OWNER EMAIL: <br /> CONTRACTOR NAME: 'r'P!D <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR XOTHER(Please Specify) A12414rrEar <br /> CONTACT NAME: CONTACT PHONE: (IS) 4p70—(ogafo X Uoq. <br /> t6144. G0144101?. CONTACT EMAIL: IGoYlnorew're1440140W1b.trowU <br /> 77,7:1777-7W-- NUIL I.NG>PERMIT"APPLICATION ._ ,:y;,7; 77,D775a <br /> Existing Use of Building: Or-RI( Contract Price of Work:$ 258.000 <br /> Proposed Use of Building: DrrlC E1 Heat Source: ❑Gas CI Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: commercial ❑Industrial <br /> Type of Project: El New ❑Addition El Remodel El Repair ❑Sign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:-me. 50cre.o i Pgo Ecr 1t,ltt.UVl:ta t1 -utvt. cemoi-1T1ogj R.P.I.oaCtTa t <br /> of PAWN Itg4 WPM N11t..1..woR,k. A14D 1:70o4,25 "40 Po40411144 . <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PRRMIT APPL'ICATI.AN=ZaPLUMBIN . ! IT APP I�ICA`i"ION y <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New Addn Alteration _Repair <br /> #of List of Fixtures #°f List of Fixtures #°f List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—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_I SUPPRESSION SYSTEIYI=, ,, <br /> !Chemical or Water 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.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 State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT 30L/-. 0IR <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />