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BUILDING / MECHANICALE PMUMBINGCATION <br /> #11111 <br /> ��IG /SIGN ( SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@eerettwa.gov i www,eyerettwa.govipermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: COIL) <br /> PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/suudsv#slog <br /> ' _WI No.' (attach copy of long legal description) <br /> CONTACT INFORMATION ' <br /> OWNER NAME: � 51/1 ,. <br /> TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET TM ,5 Catt)l <br /> e, <br /> STATE - zo 20OWNER PHONE. 72,C) <br /> 27 .r <br /> OWNER EMAIL: <br /> CONTRACTOR NAME: i n <br /> STREET CONTRACTOR ADDRESS: 14- i °a 0 <br /> a-�_}... <br /> civ ;tin , �.,fJt�'L. <br /> STATE 1. A- ZIP rr i 20 I <br /> CONTRACTOR PHONE: L.ZS Z'3ct 0560 CONTRACTOR EFa1AIL{^ fJot/tl }. (f - p - .aQ <br /> GONTRACI'4R LICENSE#:rdE+.�Et(f1ED),_ *�t R �;y <br /> �- .. CITY-OF EVERETY'f3UStNE3S LICENSE O(REQUtREDY 06 L <br /> PRIMARY CONTACT: Cj OWNER CONTRACTOR Q OTHER(Please Specify) _ <br /> CONTACT NAME: __" _, <br /> T �� CONTACT PHONE: 2 2,5L r�. <br /> L CONTACT EMAIL: , 1. 1 4_►t (,-110 .corYC ._._ <br /> • BUILDING:PERMIT.APPLICATIOst <br /> Cxistin Use of$uildln <br /> Contract Price of Work:S �f ZQ 0 <br /> Proposed Use of Building: <br /> Heat Source: )(Gas DElectric ❑Other <br /> Buddin T•pe: SFR-Detached ❑SFR-Attachad EiUu lex ❑Multi-Famil 4 of UnttS: <br /> T pe of Project: ❑New ❑Addition ❑Remodel ❑Ru ❑Commercial ❑industrial <br /> DESCRIPTION OF WORK. frau ❑Tele ❑Sign 3Serirtkler �Demolifion 1Gha t»e of Use <br /> Ill 51-e U. r 1.3 , . . In5+4tI ee.s 1.4,a4er heClfe.r= Ivt- - Ll <br /> . IvIsfrttl as p'n3 -tun-Lace1I,o& r he 4er, rain a eir- <br /> gigAL?�IL�51Nfctf1 . 9 >+ � �' - <br /> MIT#Or pplicable): <br /> MECHANICAL PERMIT APPLICATION <br /> Type of Project: New - PLUMBINGFP'ERMIT:APPLICATION <br /> Addn Alteration _Repair <br /> #of Type of Project: New Addn Alteration Repair <br /> Fixtureslt_Rl ELK tures #of !f of <br /> Fixtures` Lisi.of-ttix ores — --_____ t Cres --_._, #of <br /> A/Cliandlfnq UrTtts Fixtures List of Fixtures- <br /> Hxaf Pump Fixtures <br /> Forced Air Systems Toilet Backtitrw Preventer(inside Bid ) <br /> Unit Heater Bathtub <br /> Gas Pi ing Bonet tJnnal <br /> Water Heater Lavatory(Wash Basin) Drinking Fountain <br /> Gas Fireplace Refrigeration Shower <br /> Wood Stone Kitchen Sink Disposal Floor L"irain <br /> Gas Ranee Cuoting Grease Tra <br /> Clothes Dryer Hookups , ---------- Dishwasher Root Drains <br /> Ran e Hood Other: Clothes Washer <br /> Exhaust Fan Water Heater Other: i Gas <br /> Other; <br /> Sink(Service/Bar/Mo /etc.) giber: <br /> SPRINKLER`!SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT/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 oved work and no <br /> Building Official before being authcn'zed under/any cing of rcumstance.P mstanit oce.I am the owner,nly authorizes or am authorized byithe owneations er of this property to perform the refrom.Deviations must first ework forauthorized in application <br /> from is <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. the <br /> which made. <br /> City of Everett Official Use Onir <br /> All..—.. ;1 3 $ !e 141A. Z,C6-201 ) 625 <br /> CJw.arlAuthorLxat!Age• Signature <br /> Date (Re s'e," l2312G1 J <br />