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II-- PERMIT APPLICATK III <br /> BUILDING INECHANICAL/ PLUMBING I <br /> SIGNTSPRINKLER/DEMOLITION <br /> /1161040/ --A CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue;oir Black Ink 0inIy Pliease); `...a , ._PbROJECT SITE INFORMATION_ m *:, 9 <br /> PROJECT SITE ADDRESS: y is f r-S i ce c EvQr-Ec\kAj� PROPERTY TAX#: (:) .(c/ 003/xnRc <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER NAME: 4 - -*- o-c eve.,ce TENANT NAME(If Commercial): 7 1;,per <br /> OWNER MAILING ADDRESS: STREET p0 sz,0.4 `r3 R <br /> CITY aj-c,r.f' STATE ZIP Cy p 2_CA0 <br /> OWNER PHONE: s-( "-IapI- 1Ld1 K OWNER EMAIL: °y - ( nr�.\ n�QU�c �k. C.0sm.. <br /> CONTRACTOR NAME: e,t- s-e e.r� i rr�n 'Cjr)vrpnxr„,) <br /> CONTRACTOR ADDRESS: STREET j / ,3 Ce- i—„,l Ave Eu <br /> CITY K.eCV-Ic STATE W(-k ZIP 9(T.0.3 3- <br /> CONTRACTOR <br /> 0 033- <br /> CONTRACTOR PHONE: 025 3-g Sa- /3 5 Li CONTRACTOR EMAIL: c-],p\r� e,��� o�.p V P,!'GJ,c-ctn • C <br /> CONTRACTOR LICENSE#(REQUIRED): E eL CITY OF EVERETT BUSINESS LICENSE#(REQUIR SS lit <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: as 3_ 3 5 L/ <br /> 0%\f\;‘-t �— `c CONTACT EMAIL: r,:,tA`-e_h -2)Jer-ry-C-en Si'on • CaHti <br /> Existing Use of Building: Contract Price of Work:$ a�\ -OD <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: El Commercial tilndustrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. '$Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 1-,,1/4,0 �x r`Or W o Xe-c i-v looLV16'1 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL-PERMIT <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of ures #of List of Fixtures #of List of Fi•: es" <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Pump Toilet Backflow -venter(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Uri,• <br /> Gas Piping Boiler Lavatory(Wash Basin) Irinking 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 D Hookups Other: Clothes Wash Medical Gas <br /> Range od Water He. Other: <br /> Exha t Fan Sink ice/Bar/Mop/etc.) Other: <br /> SPRINKLER I 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.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 /> A , City of Everett Official Use Only <br /> -'t w(r /130/I? P `°�Ntgo ' O( 0 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />