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P[Ei-'MIT PPLICATI <br /> ifirf BUILDIIIW MECHANICAL I PLUMBING/SIGI RINKLER I 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 1 www.everettwa.gov/permits <br /> (Blue or lack Ink sily Please) P OJECCT SITE INF*,RMATI®N9 <br /> 0 PROJECT SITE ADDRESS: 331: 0 Y KO P L9p- 'f L PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONT<'kCT IPio RMATI®INI <br /> OWNER NAME: ei„.n i C V IJi s Ry, , C- <br /> f TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREETar { `7 <br /> CTY STATE (iffg <br /> b ZIP C/8.537 a <br /> Cy <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME; !/,h,{, r -cz ; r C •� 5 �"e t:�} �' <br /> CONTRACTOR ADDRESS: STREET )t L/l C) S . ¶T n 3O.5 <br /> crrY 'La)4 t✓ STATE L4)6_ ZIP 9 z' <br /> CONTRACTOR PHONE: �� CONTRACTOR EMAIL: <br /> ((W <br /> CONTRACTOR LICENSE#(REQUIRED): 1+I T4e..9,103-L ' 1TY OF EVERETT BUSINESS LICENSE#(REQUIRED):0�3 VS <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: t/Zc z3I- 1 q`P <br /> t VVI I el --.5 d-N-- CONTACT EMAIL: VoN) fi n; L o tto Cfi° w 60, /;1.96,.. db, <br /> a <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ ,00 0 <br /> Proposed Use of Building: Heat Source: @Gas ❑Electric @Other <br /> Building Type: @SFR-Detached ❑SFR-Attached ['Duplex Multi-Family #of Units: ,3 @Commercial @Industrial <br /> Type of Project: New ['Addition @Remodel @Repair DT.I. @Sign @Sprinkler ❑Demolition ['Change of Use <br /> DES _ PTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION -PLUMING PERMIT APPLICATION <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 #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump 3# 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 4 Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: • l Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLEI SUPPRESSIO' SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGF , 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 fed= ,state,and • al law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Buildin. official before 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 omply with the State Con -ctors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> P <br /> . IT ' O� <br /> 2. ///7 <br /> •wner/Autho ed Agen igna•ure late (Revised 9/23/2016) <br />