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PERMIT APPLICATIf <br /> - BUILDIJ MECHANICAL/ PLUM! ING/SIG PRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> 425-257-8810 J FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Ikam or Mack Ink 054 Pl 4) PROJECT SITE III FrRIVATII.;k <br /> PROJECT SITE ADDREiS: 2f/024,44 Azo A 14'/ PROPERTY TAX#: <br /> LEGAL for new construct On: Short Pladivision Lot No. (attach copy of long legal description) <br /> CTICTINIOATI .a <br /> OWNER NAME: friptilelb 7,7 ,,,6,0/ TENANT NAME(If Commercial): . 'cv '- <br /> OWNER MAILING ADDRESS: STREET <br /> CIN STATE ZIP <br /> OWNER PHONE: - •2.572� *3 i4'! OWNER EMAIL: <br /> • <br /> /1 <br /> CONTRACTOR NAME: 1 Off- Alt ely-,- 4e-e-- /i pp'L 4 r✓gic/ COAALP- ' yj g �,,e- ` <br /> CONTRACTOR ADDRESS: STREETC�-F2 g <br /> N\ <br /> CITY ; , 5 it- 1 <br /> S/9"-:2"--1 <br /> STATEZIP �/ <br /> CONTRACTOR PHONE: (� ! '/OCONTRACTOR EMAIL: �VIfr A,1: 4.4...4,-:-,05 ' < '- 'c_ <br /> CONTRACTOR LICENSE#(REQUIRED):1 `l a N V ,„,151Y OF EVERETT BUSINESS LICENSE#(REQUI-r B,': <br /> PRIMARY CONTACT: 0 OWNER l.KCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: a CONTACT PHONE: /0fl \ __ <br /> iReMa16 /hit CONTACT EMAIL: itt 00-t)Yy .---,--,ft 1 ,(i'471 <br /> BUILDING PERMIT APPLICATION <br /> OOExisting Use of Building: Contract Price of_Wirk:$OV <br /> Proposed Use of Building: • Heat Source: DGa�DElectric El Other <br /> Building Type: @SFR-Detached @SFR-Attached @Duplex @Multi-Family-#of Units: ® naerei @Industrial <br /> Type of Project: @New @Addition El Remodel 1:1 Repair DTA. @Sign , @Sprinkle,, ❑Demolition @Change of Use <br /> DESCRIPTION OF WORK: ' G�a—.�W �/1 �f <br /> h lit )� dr- ( t,,...4-i..... ‘ p <br /> ASSOCIATED BUILDING PERMIT#(if applicable): t,1f o-112_- _ -'- "`t_ - <br /> MECHANICAL PERMIT APPLICATION PLMRING PERMIT APPLICATION <br /> — <br /> Type of Project: _New Addn Alteration _Repair Type of Project: _New Addn _Alteration _Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures fixtures List of Fixtures Fixtures List of-'-ores <br /> A/C-Air Handling Units Heat Pump Toilet Backflo "reventer(Inside Bldg) <br /> Forced Air Systems Unit -rater Bathtub Ur:, <br /> Gas Piping :oiler 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 Dryer •• ups Other: • Clothes Washer Medical Gas <br /> Range Hoo. Water Heater Other: <br /> Exhaus 'an Sink(Se .' e/Bar/Mop/etc.) Other: <br /> - <br /> SPRINKLE: I SUPPRESSION SYSTEM _ _ <br /> —Chemical or Water [ JNo.of Heads ' <br /> oti <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 beinguthorize --h der any circum�stance.I am the owner,or/am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the StateContr f ors L 18.27 R-V7and'296.200A WAC. <br /> / ,' J� j,,''`- City of Everett Official Use Only <br /> f*Z4,./773,- �0 /1r <br /> / / , PERMIT# i <br /> /:(7t <br /> Owner/Authorized Agent Sdgnature Sate % (Revt 9/23/2016) <br /> v% l� t2 0` <br />