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ZI <br />PERMIT APPLICATIO <br />BUILDINAECHANICAL / PLUMBING / SIGN WRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 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:2!114 W ► <br />AWOLPROPERTY <br />TAX #: <br />00 QQ <br />LEGAL for new construction: Short Plat/subdivision <br />Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: 516 L.0 NV LL4., <br />TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET 10 <br />I've. S. <br />CITY ` . <br />STATE w <br />ZIP `Q <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR NAME: rx <br />CONTRACTOR ADDRESS: STREET <br />CITY <br />STATE <br />ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIR D): <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR XOTHER (Please Specify) <br />-- <br />CONTACT NAME: <br />�I �r.IC�'11`l �E I MEPL'S A1 � <br />CONTACT PHONE: • <br />CONTACT EMAIL: M re � me CS Gang G1ar�N� }tC►h�f'�G <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: ��� <br />Contract Price of Work: <br />. .0— <br />Proposed Use of Building: -pe )I Pro- <br />Heat Source: ❑Gas []Electric <br />❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi -Family-# of Units: Xcomm­ ❑Industrial <br />Type of Project: ❑New ❑Addition emodel ❑Repair <br />❑T.I. ❑Sign ❑Sprinkler on <br />❑Change of Use <br />DESCRIPTION OF WORK: <br />C4*- �� l (� V s're� r\(_0 Q13',151P ' <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration <br />_Repair'` <br />Type of Project: _New _Addn <br />_Alteration _Repair <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />,List of Fixtures <br />A/C - Air Handling Units <br />Heat Pump <br />Toilet <br />Backflow Preventer (Inside Bldg) <br />Forced Air Systems <br />Unit Heater <br />Bathtub <br />Urina <br />Gas Piping <br />Boile <br />Lavatory (Wash Basin) <br />Drink <br />g ountain <br />Water Heater <br />Refr ation <br />Shower <br />Floor in <br />Gas Fireplace <br />d Stove <br />Kitchen Sink & Disposal <br />r e Trap <br />Gas Range <br />ucting <br />Dishwasher <br />oof Drains <br />Clothes Dryer Hookups <br />Other: <br />Clothes Washer <br />Medical Gas <br />Range Hood <br />Water Heater..," <br />0 <br />Other: <br />Exhaust Fan <br />Sink (ServjceiBar/Mope <br />Other: <br />/ <br />'f .. <br />SPRI <br />NKLqK/ SUPPRESSION <br />SYSTEM <br />Chem ic or water <br />INo. <br />of Heads <br />ACKNOWLEDGEMENT: 1 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. l am the owner, or / am authorized by the owner of this property to perform the work for which application is made, <br />and / comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PE T # <br />X-) ( <br />�O <br />(Revised 912312016) <br />w <br />