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rttelflII APPIUGATIo <br /> ,/."--4 Ull L 9 'MECHANICAL/PLUMBING /SVG ��- RlNKLER/ DEM��L TION <br /> 4 � ,-1 CITY OF EVERETT PERMIT SERV <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 or Black ink Only Please) PROJECT SiTE INFORMATION <br /> PROJECT SITE ADDRESS: f Y ('e�r Yl. <br /> ,J <br /> ,ice PROPERTY TAX#: a / a 5 <br /> LEGAL for new constructiofi: Short Plat/subdivisioj() n Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: /3.P.S-("W f tP-4(1 N IVA- INN TENANT NAME(If Commercial): <br /> ,f, elegt kieseert. Pius <br /> OWNER MAILING ADDRESS: STREET i5D v /064-k-1 V 1!s 4 S w t /Q4 / `� <br /> CITY ti /*fl faQY STATE ZIP q03'r� <br /> ! <br /> OWNER PHONE: -2057' t 1 a5-5--,5-- (OWNER EMAIL: <br /> CONTRACTOR NAME; 1100th- Wo)4t. <br /> CONTRACTOR ADDRESS: STREET .1a 1 59,141 gem C --J � <br /> CITY C-��h�'� " 7 � <br /> ° STATE 4 C7,63/0,9 <br /> 17 3/ <br /> CONTRACTOR PHONE: QV (12 5 30'00 'CONTRACTOR EMAILC 9-CL .C, g jzi/6r i-,G - <br /> CONTRACTOR LICENSE#(REQUIRED): 14EaTifKJ E q8( re (CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): [r/-119 19 <br /> PRIMARY CONTACT: 0 OWNER .CONTRACTOR 0 OTHER(Please Specify) <br /> CON CT NAME: CONTACT PHONE: w 643 -3 i _ <br /> ONSfrZi Wft* ( CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: f,kytei'_/ft4O1 t-- Contract Price of Work:$ '7 4 )(' <br /> Proposed Use of Building: b ) tellme.l-:et. Heat Source: ❑Gas CI Electric DOther <br /> Building Type: DSFR-Detached DSFR-Attached ODuplex ❑Multi-Family-#of Units: Itommercial Dindustriai <br /> Type of Project: DNew DAddition DRemodel DRepair OT.I. ign DSprinkler DDemolition DChange of Use <br /> DESCRIPTION OF WORK IR���T tOn_ ( - - _ <br /> gfil, Qii<awk Q004( cRod P_ /- gyre er, plus. ,..., <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL 'P.ERMiT APPLICATiON PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn Alteration _Repair Type of Project: New Addn Alteration _Repair <br /> List of Fixtures #of <br /> Fixtures gist of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures List of Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub • <br /> Urinal <br /> Gas Piping _ Boiler Lavatory(Wash Basin) •Drinking Fountain - <br /> Water Heater Refrigeration Shower <br /> Fireplace * <br /> Gas Floor Drain <br /> 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 <br /> Sink(Service/gar/Mop/etc.), Other: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> , 111 <br /> ACKhiOWLFDGEMEPIT.I have reviewed thisNo.of Heads <br /> Chemical or Water <br /> 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 ufhorized 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 compl the State Confracf f - -t8.'"7 RC W a,d 296.200A WAC. <br /> City of Everett Official Use Only <br /> 41111(..._ , 411/ .... � PERMIT# <br /> +� �� 1,05s0/5 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />