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wPly 71-etB <br /> PERMIT <br /> IIII II 'I <br /> BUILDING 1 MECHANICAL/ PLUMBING /CSIGN NRN <br /> /SI5RINKLER/ DEMOLITION <br /> 7/#414 CITY OF EVERETT PERMIT SERVICES 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 VNCTS f-61„ <br /> PROJECT SITE ADDRESS: folio `1t-1 '` 515515eevere4- ,WA4 4 q 940 oo <br /> PROPERTY TAX#:a oOSOB0oao`b <br /> OQ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:V 1"Akt ANA r N ?SCS'\Q.C( TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET �j\�p�,o vJ Ac,, ..;A-\e Q MO.\ A <br /> CITY Eve re -1- STATE wA ZIP A\Fe9423 <br /> OWNER PHONE: QO6 Sg - Logi OWNER EMAIL:P4,iJVLA OT \-W1 MAIL. CC A'( <br /> CONTRACTOR NAME: S AM E QHS ply A) e Z <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: NER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 006 -35-3- L/thy <br /> J t4 - � �rl,`i` CONTACT EMAIL: NANVL.40-K Q 1 o-rptAn,• cOm <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Va-CQv1/4.3t Lai Contract Price of Work:$ <br /> Proposed Use of Building: 12es e...a=t\ \e( Heat Source: ❑Gas n€lectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached Qplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: PM-NW ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: p nn <br /> New cav5c..c�',D., D 4 of LA.K r c,k gkeyl <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 /> gs, A/C—Air Handling Units a Heat Pump - 6 ' Toilet Backflow Preventer(Inside Bldg) <br /> a Forced Air Systems Unit Heater Li , Bathtub Urinal <br /> Gas PipingBoiler VI,%. Lavatory(Wash Basin) Drinking Fountain <br /> a. Water Heater Refrigeration Lk Shower Floor Drain <br /> Gas Fireplace <br /> X <br /> Wood Stove a. ,' Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting a . Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: a, / Clothes Washer Medical Gas <br /> a Range Hood 1 Water Heater Other: <br /> ' 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 •. .ly with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 110 PERMIT# <br /> Og115 it (' (go g -0401 <br /> horized Agent Signature Date (Revised 9/23/2016) <br /> 9 9 <br /> I <br /> V <br />