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PERMIT APPLICATI <br /> Jayill°111P BUILDINIOMECHANICAL t PLUMBING/SIGNTSPRINKLER/DEMOLITION <br /> �''' CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425 257-8810 f FAX 425-257-8857 )(E)everetteps@everettwa.gov j www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please). PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ; iq S _ ._ _ <br /> 6 - PC SVC"O rrN8 'PROPERTYTAX#:�QG1`-\` 0C)CDOCY-D(DS <br /> LEGAL for new construction: Short Plat/subdivision ------ Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: P-C(k(C S3 co..IrliNe1S TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srmacr 3(47,2 (a 74-4 4 cie. iv <br /> CITY Ma8rASS)t e_ STATE (A) 4 ZIP Cie 2 70 <br /> OWNER PHONE 142,5- 210-Z-2 3 !OWNER EMAIL: <br /> CONTRACTOR NAME: 1"4Cx0,ck Gip- -ere I-16 ve S <br /> CONTRACTOR ADDRESS: STREET 3 c12 2 e-Tit A e <br /> CITY no1/4r .‘k STATE lJ\J IA ZIP I Z i 1 10 <br /> CONTRACTOR PHONE: 1 ZS-?_go—2 Z 9 'CONTRACTOR EMAIL: 0 oe k p hCketCk 1/jr0- eii, (CI/V\ <br /> CONTRACTOR LICENSE#(REQUIRED): 1-qqttc C3 ,0 l a i)Z ICnY OF EVERETT BUSINESS LICENSE#(REQUIRED); 053%C,7 <br /> PRIMARY CONTACT: ❑OWNER CRCONTRACTOR 0 OTHER(Please Specify) <br /> !CONTACT NAME: CONTACT PHONE: 42,5=Zelo-Z'I Z 9 <br /> DOet HctQC CONTACT EMAIL:(jOe oehQOL A.I3re 4-hers,c 0 IV% <br /> I <br /> BUILDING PERMIT APPLICATION _..-. . <br /> Existing Use of Building: Contract Price of Work:$ 5-0 OC) <br /> Proposed Use of Building: 'r`)VtQ'E k Heat Source: Gas OE le c ClOther <br /> Building Type: OSFR Detached ❑SFR Attached ®Duplex ❑Mulfi-Family#of Units`. __ OCommercial Dlndustrial <br /> Type of Project: EINew DAddition DRemodel DRepair OT.I. OSign OSprinkler ❑Demolition DChange of.Use <br /> DESCRIPTION OF WORK: <br /> e der <br /> r. <br /> %SSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> ype of Project: New _ Addn :Alteration Repair Type of Project: New Addn Alteration Repair <br /> #of List of Fixtures #of #of <br /> Fixtures Fixtures List of Fixtures Fixtures List ofFlxturea #of List of Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet Fixtures <br /> tl Forced Air Systems Unit Heater Urinal w Preventer(Inside Bldg) <br /> Bathtub <br /> to Gas Piping Boiler LavatoryUrinal <br /> Water Heater Refrigeration (t f6 Shower (WashFl Basin) Drinkingorr Fountain <br /> e Gas Fireplace Wood Stove ' Greaseoer Drain <br /> � Gas Range Kitchen Sink&Disposal Trap <br /> Ducting v. Dishwasher Roof Drains <br /> - Clothes Dryer Hookups Other: a Clothes Washer <br /> dl Range Hood Medical Gas <br /> Water Heater Other: <br /> ' Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> 'Chemical or Water I 'No.of Heads <br /> '3KNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this <br /> ermit mustrrrent federal,state,and focal law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing�froly with <br /> m the <br /> eliding Official before being authorized under any circumstance.I am the owners on am authorized by the owner of this properly to perform the work for which application is made,. <br /> rid I comply with the State Contract Law 1827 RCW and 29&200A WAG <br /> 4 <br /> City of Everett Official Use Only <br /> f .'1-0 '-'( 1 PE`/pj••ry�T f� /� <br /> .,z <br /> fined• zed Agent Signe vvv Date L <br /> (Revised 9/23/2016) <br />