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PERMIT APPLICATICm 1. <br /> 4en. DUILDII Il4 MECHANICAL/ PLUMBING /SIGINI RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> T <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: /g o 7 e2 ,. t PROPERTY TAX#:00 7 tem 0000 TOD <br /> LEGAL for new construction: Short Plat/subdivisionC$ y AI Lot No. 7 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: /1/44- .e C Lifit red/ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET/41010 4771, p I s <br /> CITY aYR._. STATE Y ZIP <br /> OWNER PHONE: to c . ,� OWNER EMAIL: -46 t.' ", <br /> e - G oo«{{{ <br /> CONTRACTOR NAME: 1�.� <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 0 OTHER(Please Specify) <br /> CONTACT^ Z NAME: CONTACT PHONE: £/ 5- .3/ -! 73 <br /> ^ <br /> /`' L A,Tr S t,,v'rc i / CONTACT EMAIL: ..1 1,60C./ e r 14,./0). Cpl <br /> BUILDING PERMIT APPLICATION <br /> h , <br /> Existing Use of Building: $ A / res# Ake,, - Contract Price of Work:$ I V OD, <br /> Proposed Use of Building: iffiHeat Source: ❑Gas lectric ❑Other <br /> Building Type: ;SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family #of Units: ❑Commercial [Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition iliihange of Use <br /> DESCRIPTION OF WORK: <br /> vel" it" 440 v i 1" I ly Hoist"C.- <br /> -ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn _Alteration Repair Type of Project: New _Addn _Alteration _Repair <br /> #of #of List of Fixtures List of Fixtures #°f 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 /> SPRINKLER 1 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 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.t 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 /> 2/1 j (. . PERMITS 19)\ ^ Ob^ <br /> _...5 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />