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RMIT <br /> BUILDING ) MECHANICALEI PLUMBING C <br /> NG SIGN SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 10447T 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: (76/7 ! .g �-,�/--:- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: / .. ` /11)2,[�i /ii___„/ ENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET J"'dram � ,¢per c- <br /> �' .7/?(. ›,)2(6 CITY ti,,,e1 STATE at? ZIP ��/ <br /> i <br /> - <br /> OWNER PHONE: fl'13 2`"l2-- OWNER EMAIL: <br /> CONTRACTOR NAME: C , <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: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: r/��--7? ./ 71--- <br /> /6/7( <br /> 7' �_ <br /> b b / ii -7��.0,-fo �7 c_ CONTACT EMAIL: �� / <br /> BUILDING PERMIT APPLICATIO <br /> Existing Use of Building: Contract Price of irk:$ k 30 <br /> Proposed Use of Building: Heat Source: 0G. DElectric ❑Other <br /> Building Type: DSFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family-#of Units: ❑Come= ❑Industrial <br /> Type of Project: ❑New DAddition DRemodel DRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: jp G/7 .O ��2,, f�7 r0A Shp3.a�� <br /> l,l e 1��G�acN' P�G <br /> So <br /> ��� �� eve- ) Te-f- #0�J "7i_. ,� �1.�� (AA-C.4_ �-cJL(-- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): /y 9d`tC /©ice C'+).--t7� PSc ���L ' lAcizarri_ <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 y Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater / Bathtub Urinal <br /> Gas Piping Boiler `, Lavatory(Wash Basin) Drinking Fountain <br /> 2 Water Heater .` Refrigeration / Shower Floor Drain <br /> Gas Fireplace Wood Stove d Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting a Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: / Clothes Washer Medical Gas <br /> j Range Hood J Water Heater Other: <br /> /_� Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER!SUPPRESSION SYSTEM <br /> Chemical or Water I 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 /> /� PE zO� .co <br /> ineth zed a Signature fD�te (Revised 9/23/2016) <br />