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Oreerr PERMIT APPLICATIOIA <br /> BUILDING ECHANICAL / PLUMBING / SIGN WPRINKLER/ DEMOLITION <br /> 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: WOO 23' `l Or' i/ PROPERTY TAX#: ,2--g'G 1C Ct--'3C l e67o <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: /t/;GJ'k ISc 4 i (../?'-ne -4- )et-11i lL CA." / TENANT NAME(If Commercial): Teotgvtt l�r�ciwrli✓lr.� <br /> OWNER MAILING ADDRESS: STREET 6C.00 3' • t),- A,/ J <br /> CITY l/e/V'ert STATE W/ 1 ZIP c1k,2C j <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Patriot Fire Protection, Inc. <br /> CONTRACTOR ADDRESS: STREET 77(17 7(1th AvP F CITY Tacoma STATE VV`/�' <br /> A ZIP 98424 <br /> CONTRACTOR PHONE: 253-926-2290 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): PATRIFP02AC;F CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 024694 <br /> PRIMARY CONTACT: El OWNER ® CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:„ZSS?- �'�6— 2.610-\\ <br /> 2fiWI-P1 6j1l✓%51-ePiSov) CONTACT EMAIL:Jav,,4G4,u-,S '.-isc 671X'ro 'i're-c:v4r <br /> BUILDING PERMIT APPLICATION <br /> �� �L'�c <br /> Existing Use of Building:C���L(?/''iGr'+�(7"�aL7`-i,t.v'f%i1 e; _Contract Price of Work f, l✓ ,. C�L� <br /> Proposed Use of Building: t Heat Source: CI Gas DElectric ❑Other <br /> Building Type: DSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: OConimercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel El Repair I. ❑SignG�Sprinkl r ❑Demolition CI Change of Use <br /> DESCRIPTION OF WORK: "lc6,{ ex13rr, y Si''^1v1 k/e✓' Sys-tt;wl 7c i-7eIA. -'loci.-t 1- i,-9.4,-cvevtie.-vt <br /> wall and cerl,19 64y,i,Lt, 3 5 la rf,4 /e,-- 1'zectd <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 /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of 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 n Sink(Service/Bar/Mop/etc.) Other: <br /> SPfiINKL R/ S PPRESSION SYSTEM <br /> 3 Nu er of Heads <br /> ACKNO EDGEMENT::I hav eviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br /> current fe eral,state,and I I 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 O ' ial before trig 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 comply witfe State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> � �,, � PERMIT# <br /> Az�- .--r e-,�, /LVI7 K 1 "? 4l g. 0 36) /12: <br /> Owner/Authorized Agent Signature Date (Revised 5/20/2016) <br />