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4rETT PERMIT APPLICATIO <br /> BUILDIANIECHANICAL/PLUMBING/SIGN PRINKLER/ 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: 5/33 4 v4i'T4i L/F YI O1 PROPERTY TAX#: a��/ 6' 1 <br /> 7 yilore <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 7 P®,/l.4iV® TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET '/4 ,'L7,%��J . A� 7,y <br /> CITY i t lL/7 STATE Ain ��I ZIP fi./�l/ <br /> OWNER PHONE: y.2b, 3 f i423 OWNER EMAIL: T 2 ,4y/, Aid , , /4 //i.Coi'i9 <br /> CONTRACTOR NAME: PAL, / /A/r_ //�� <br /> CONTRACTOR ADDRESS: STREET .74 ALA_�(4 ' /e,e9 <br /> CITY 44 7r STATE L/f' ZIP f . .e./ <br /> CONTRACTOR PHONE: j 3 yr, I®©.s CONTRACTOR EMAIL: Thaaijilwefrigi/l 1/1 1,.i;DYJ,) <br /> CONTRACTOR LICENSE#(REQUIRED): 6,ljl// 1 89 g, Z. CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0 y/r_ o'7 <br /> PRIMARY CONTACT: N OWNER X CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ,(/�7� 7(J <br /> `-egg 2 /� j CONTACT EMAIL: %' iodAv/ jj e_ �,��4/L a Ch".1 <br /> iV� BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 14A Contract Price of Work:$__ ca4 09 <br /> Proposed Use of Building: 6 Heat Source: XIGas ❑Electric baOther <br /> Building Type: RSFR-Detached ❑SFR-Attached ['Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project ❑New ['Addition jaRemodel ['Repair OT.1. ❑Sign ['Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> r0gli, Mi4t Pniml Ixrsnr 441- 1,40 I EiloriCsk. i 11 rz4 Ar,4/✓44, <br /> vp4 o o t 4 6yfTeei r. ,E n 10, <br /> ASSOCIATED BUILDING PERMIT#(if applicable): V V ` up) <br /> MECHANICAL PL <br /> PERMITAlteICATION PLUMBING PERMIT APPLICATION <br /> Type of Proje tNew _z ratio _Repair Type of Project: Few--- Add"i\(ZAlteratio _Repair <br /> #of List of Fixtures #° List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures 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 /> S Y Gas Fireplace Wood Stove / Kitchen Sink&Disposal Grease Trap <br /> i Gas Range Ducting / Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: / Clothes Washer Medical Gas <br /> / Range Hood ' Water Heater Other: <br /> a Exhaust Fan / Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I INo.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!comply with th e Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> i// PE iT#i 2 o D 00 <br /> Owner/Autho .d Agent Signature Date (Revised /23/2018) <br />