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A <br /> T <br /> BUILDINh 1 MECHANICALS PLUMBING CSIGN )SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 0477 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: *0d 7E F•64-I...�i'2• PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: G�1,--4d1.{6•4es{!f-,j Gduf...t `Z' TENANT NAME(If Commercial): h1 F-I6NAI' (-4uft ? <br /> OWNER MAILING ADDRESS: STREET ,/),O0 ?_LIL s( (�;42- INN;SrS+I� \� Za <br /> CITY ..VV- ' ' STATE WA ZIP %820t <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: ' 4:5•44A/Vis <br /> CONTRACTOR ADDRESS: STREET Q I(p `-' <br /> CIN 5V-'r��. STATE y� ZIP ��t <br /> CONTRACTOR PHONE: 244,244,• 4/& •D-7 Z.. CONTRACTOR EMAIL: [....45r( c-r-r Dt"'I'I Ie3G� •Gd t'!�I <br /> CONTRACTOR LICENSE#(REQUIRED): FEMA GG 8113 O CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): O' 4 3c16 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR MOTHER(Please Specify) 4.•i-�1-4rraGf <br /> CONTACT NAME: CONTACT PHONE: �/L • 2sco .,„668 <br /> 10V-V(14 ' A'((.4 4Z. CONTACT EMAIL: d,eetrmi (":;'1dI^G�'I.LGCt`1 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: t j� tib• OGG• Contract Price of Work:$ 2 g� 2 S i. Qc2 <br /> Proposed Use of Building: 401S/VS461411/ i p�G • Heat Source: VGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: i'Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ORemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> NSl C4 4 {ZE7y'1�7�L, a 6>c(�. ' t t�f G.r GL.E'�k� ' ( -61:7,44.E. .04 <br /> -ti-E. hEGb1 1V rL4?:47- der 1146. #71(. (-{";46,-44doJ(41 ( `icAw-,e7(e)ici U(C.74-4C7 <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 List of Fixtures #°f List of Fi•• es #of List of Fixtures #°f List of Fixt -:Fixtures Fixtures Fixtures Fixtures <br /> NC-Air Handling Units H-. -ump Toilet Backflo - -venter(Inside Bldg) <br /> Forced Air Systems nit Heater Bathtub U ' - <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Dispos. Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dry- ookups Other: Clothes Was - Medical Gas <br /> Range H.•d Water He. -r Other: <br /> Exha Fan Sink .-rvice/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 /> / City of Everett Official Use Only <br /> PE T# <br /> — I .140.MW I •17 ( • \lol oq3 <br /> •„ - u o ized Agen igna ure/ Date (Revised 9/23/2016) <br /> d-D <br />