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elp PERMIT APPLICA`f1 <br /> BUILDIMECHANICAL I PLUMBING/SIG'.• PRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SER <br /> a 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 Block'LA.Onlly Please) PROJECT SI'T'E INFORMATIO <br /> PROJECT SITE ADDRESS: SI OS- Pi`0.�Si' Jverr (474 - 93 ZOI PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION : <br /> OWNER NAME: 14o((i d0- /n V.ef rvain 4'S TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1I61 COtMt(b p'r-G.i .I S.#!6S- <br /> cTY Eel/,ji(rj-1••wal STATE vA • ZIP !g z2S. <br /> OWNER PHONE: (360) 2.0?_ IZSACO6 91416. OWNER EMAIL: Se(.Se KKt(d ctersnvact-men4._Co�,, <br /> CONTRACTOR NAME: 01^'Y( fit''. <br /> CONTRACTOR ADDRESS: STREET <br /> CIN STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: !4 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: f CONTACT PHONE: <br /> r' �"n \"IP " c'2 ( CONTACT EMAIL: <br /> ' BUILDING P RMIT APPLICATION - ' <br /> . . ; : B <br /> B IL ING E.:... . . . - . <br /> Existing Use of Building: h. Contract Price of Work:$ I'-00 V <br /> Proposed Use of Building: M 46( Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family#of Units: ^commercial ❑Industrial <br /> Type of Project: ONew DAddition El Remodel ❑RepairT.1. El Sign OSprinkler ❑Demolition El Change of Use <br /> DESCRIPTION OF WORK: 6-Ve 5j+(O0IM MOC ICkIP -C)( .v 4.-,,Y - ce a at,E4-i-9 Ii <br /> biKSJ 1L1 (161 .) CO/ ?, <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL:PERMIT APPLICATION ' - . PLUMBING PERMIT.: LICATION <br /> Type of Project: New Addn _Alteration Repair Type of Project: New Addn Alteration _Repair <br /> of List of Fixtures #°f List of Fixtures #°f List of Fixtures #°f 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 Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking 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 Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION:SYSTEM.,' . <br /> Number 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 /> PERMIT# <br /> Owner/Authorize311/z <br /> gent Signature Date (Revised 5/20/2016) -�'r <br />