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P <br /> DUILDIRlA 1 MECHANICALLEIRPLLUMBIN/CS GNV SPRINKLER/ DEMOLITION <br /> O <br /> i'*�'` CITY OF EVERETT PERMIT SERVICES <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:M(9 fi(eli 6 6 1: PROPERTY TAX#:M9150C"930 <©n <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: k )VD is 0 t „s A k TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET T,0 , B a x 13 <br /> CITY /N. 61gOk S STATE ��s ZIP <br /> OWNER PHONE: -7 ,_5o $ - 6.14 OWNER EMAIL: ALIAArMQY)/Q 6 q 4/4 .a, <br /> CONTRACTOR NAME: /9 P iNIOADNIP6 i&k <br /> CONTRACTOR ADDRESS: STREET, I.O 1'0 . BO ) 135 <br /> CITY kk' c;.. 77vfiu5 co-A STATE ZIP <br /> CONTRACTOR PHONE:764,7'`1 (C,, CONTRACTOR EMAIL:RA I,EC G Pig(W C, �jt,(4, R <br /> CONTRACTOR LICENSE#(REQUIRED OL 1-k 94 Q.93 k/ CITY OF EVERETT BUSINESS LICENSE#(REQU D): scpt <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) ___5D <br /> CONTACT E: CONTACT PHONE: <br /> PW'CL.._ k-- _ CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ '':+17:7)00 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ... ❑Commercial ❑Industrial <br /> Type of Project: El New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler,'. Demolition ❑Change of Use <br /> DESCRIPTION OF WORK• a <br /> 06/0 CZ E-Ai �/ tt, EAL,,ti &, <br /> lir <br /> ASSOCIATED BUILDING PERMIT#(if applicable): "`5r& &$ <br /> d <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of #°f List of Fixtures List of Fixtures #°f 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 /> Chemical or Water 1 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 befor-being- thorized under any circumstance.I am the owner,or l am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the .tate q tr. .rs Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> `-11i 1 / I 7 PERMIT# ( SO D� <br /> 1 <br /> Owner/Authorized Agent Signature ate (Revised 9/23/2016) <br />