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SIP Hi <br /> BUILDING MECHANICAL PLUMBINGPERMIT, APPLICATION SIGN SPRINKLER/ DEMOLITION <br /> viiii CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: \3 <br /> / LAL 46 6 PROPERTY TAX#: 005 6'87 72700AD <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> L CONTACT INFORMATION <br /> OWNER NAME: / � <br /> � n C R£/3 o,z/ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /?®Q &1,4iJt) An., lifin3 <br /> cm, Edo/PE-Tr STATE (JJJ4 ZIP /A)70 I <br /> OWNER PHONE: c;?0 3 3 /1394/ OWNER EMAIL: f ROC, /67E/ SCM- Penpoi4s7, NET <br /> CONTRACTOR NAME: W AJ€ • _ _ �, <br /> CONTRACTOR ADDRESS: STREET %._ v <br /> CITY _ <br /> _ STATE ZIP AM9,9,204, <br /> CONTRACTOR PHON , j-y J?` <br /> !✓ rQ_j CONTRACTOR EMAIL: • <br /> CONTRACTOR LICENSE#(REQUIRED): J - _- , CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CON ACT NAME: /j CONTACT PHONE:/I9 $SS °& ?9' <br /> 7 <br /> //gm 1 E, .ho <br /> 5/SC/7L - CONTACT EMAIL: 7�cA1 E, 4)6 CH6/0 O/467.WE/- <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: G`/./6/, C FA/ 1/L-y Contract Price of Work:$ 9 7 2 � <br /> Proposed Use of Building: G/ A/&L`c. `ftfvI/L 0 Heat Source: ' Gas ❑Electric ❑Other <br /> Building Type: ]SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New LVAddition ❑Remodel ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WO K: <br /> fe# 1,7 A opo st ,t3n,sepv4ear kils)?k ComOaITzo CVO , -PeR viirf1c <br /> 4AR COQ pco -io c2 O7-, f'�/c ,r 3 51,9L/6-N1 /*a seo eDtiliL Thi ).4. <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 #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump / Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Gi Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration gAir Shower Floor Drain <br /> Gas Fireplace 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 /> cl. Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I 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 Cont tors Law 18 7 RCW and 296.200A WAC. <br /> w City of Everett Official Use Only <br /> PERMIT# <br /> el, <br /> . T ow i go3 --® - <br /> Aw 'r/Authorized A Signature Date (Revised 9/23/2016) <br /> ( l ,, <br />