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P <br /> RIT <br /> BUILDING/MECHANICALS PLM <br /> U MAPPLICATION <br /> �G_ CITY OF BING /SIGN /SPRINKLER/DEMOLITION <br /> EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 ((E)everettepst everettwe.gOv I www.everatt ra.geWper nits <br /> (Blue or Black Ink Only Please) <br /> 'I R ?JECTIlTE;INFORMA`1r`ION " _,: <br /> PROJECT SITE ADDRESS: 02 .: 0 Ave. I <br /> LEGAL for new construction: Short Plat/subdivisionPROPERTY TAX#: <br /> --�—___ Lot No.__ (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: r Air, •GLrheS <br /> TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREF1 5302 <br /> CITY ./.Jim p <br /> OWNER PHONE: 77--e) Q T —---• STATE zrp /g, 3 <br /> i t7 d OWNER EMAIL: <br /> CONTRACTOR NAME: ''' r <br /> in Ivtc_ <br /> CONTRACTOR ADDRESS: ![�, <br /> sra::ur 0 C.. ill <br /> CITY qii. • jAZt. <br /> CONTRACTOR PHONE: 0 STATE A I '- ZIP # o 0 I <br /> so CONTRACTOR EMAIL• , 4't 'It <br /> CONTRACTOR L1GEhlSE;#REc�Uff��f3}: ,r, �: .II.;t1 .AA _ _III I�/ ,Co:7� ,,- *. Clm'OF EVERETT BUSINESS LICENSE#(REOUIREDY f oa <br /> 9 gPRtMARY CONTACT: O OWNER d CONTRACTOR <br /> 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> CONTACT PHONE: 4.2s 259' c)550 <br /> CONTACT EMAIL: r A `_e <br /> Bt LthING. E3IMI I APAP[I(:��4TION S .',.. ,.. <br /> Existln Use of Bulldin : • <br /> Contract Price of Work: $ 520 <br /> Proposed Use of Buildini <br /> Building I no rwS CF Heat Source: CGas 0Electric ❑Other <br /> SFR-Detached CISFR-Attached COu Ilex ❑Multi-Famlit �of Units �m ❑Commercial ❑Industria.._lT pe of Project: ONew OAddition ❑Remodel <br /> DRepair OT.I. OSlin ❑S rinkler ❑Demolition OChan <br /> DESCRIPTION OF WORK: ) p r, <br /> 1 n yrs"-�-�'.i i 5(15 9e of Use <br /> ASSOCIATED BUILDING PERMIT a pplicabble Lk i (fu)�_� Lye.vt---F--) <br /> MECHANICAL PERMIT APPLICATION <br /> Type of Project: New Addn PLUMBING PERMITAPPLICATION <br /> Alteration _Repair <br /> #of Type of Project: New Addn ._._Alteration _Repair <br /> Efxturas l f&t. t_Fixluces Fixtures 1-1 <br /> __ #of #of <br /> st.of-Fixtures.— _ _ 154-of Fixtures #o/ <br /> A1G—Air Handling Units Fixtures — — isEpf Fixtures —--___ <br /> Heat Pump Fixtures <br /> Forced Air Systems Bali t Backflow Preventer Inside Bldg)Toilet Heater Bathutt <br /> Gas Piping IIIIIM Boiler MIN Urinal <br /> ��� Lavatory(Wash Basin) Foonkin. Fountain <br /> Refrigeration Shower <br /> aumenzamommon mem Wood Stove Kitchen Sink&Oissosal Grease Drain <br /> illnall Ducting Tri. <br /> Clothes Dryer Hookups Dishwasher Roof Drains <br /> Range Hood Other: Clothes Washer <br /> .........___Milli <br /> 111111111 Water Heater Othr:Medical Gas <br /> Sink(Service/Bar/Moe/etc.eff8ar/F 9opletc. Cit er: <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 <br /> current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first he authorized in writing from <br /> Building Official before being authorized under any circumstance./am the owner,or 1 am authorized by the owner of this property to perform the work for which application <br /> the <br /> nyihest made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAG. <br /> • <br /> City of Everett Official Use Only <br /> 1/ �� PER IT# <br /> Ow,eriAutho d Age. Signature <br /> Date i 1 f f' '' !O �� <br /> Date (Revised 9/23/2016) <br />