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PERMIT APPLICATIO <br /> 477 BUILDIN MECHANICAL/ PLUMBING /SIGN INKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVIC <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 l(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION. . <br /> PROJECT SITE ADDRESS: 12 3 by, pit,k_ti iv4PROPERTY TAX#60,17100 cx, v6,00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ;CONTACT INFOR.MATIION : <br /> OWNER NAME: e r 4 4--.ev'41 TENANT NAME(If Commercial): .,./'..- <br /> OWNER <br /> /OWNER MAILING ADDRESS: STREET 192 3 A pi) k.1+e,, A/v d <br /> CITY 'Civae,,,,/Z 1+ STATE kAA q n ZIP 9�2 03 <br /> OWNER PHONE: Lid,fj 36 - O( cj 1 6r e P.✓ 12( l ,,,S.i•CG <br /> OWNER EMAIL: .2 S <br /> CONTRACTOR NAME: G r'vl.Q- Q g 0 W•Q;'" <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: la OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 42 4-,--3 3o—5c1/4. <br /> /re„,) g,g,@„ S CONTACT EMAIL: r e.QJQ S .7-Q ifilcvi _CC;"" <br /> . BOILDING-PEMVIErAO.PLICATXON ._ <br /> Existing Use of Building: 5 Pk Contract Price of Work:$ <br /> Proposed Use of Building: 5 F I Heat Source: ❑Gas ❑Electric ❑Other, <br /> Building Type: @SFR-Detached @SFR-Attached ❑Duplex ❑Multi-Family-#of Units: @Commercial ©Industrial <br /> Type of Project: ONew @Addition @Remodel @Repair DT.I. @Sign ©Sprinkler ODemolition @Change of Use <br /> DESCRIPTION OF WORK: <br /> � <br /> a4- w �o 2— �c,P rial5. s N r�g7S� <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 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.lam the owner,or lam authorized by the owner of this properly 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 /> //' / <br /> -- /� PERMIT#. t inDI Ol <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015)1Il <br />