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+ PERMIT APPLICAT101111 <br /> DUILDI#/MECHANICAL/ 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 j www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 301 4 Haft a V � 4c) PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision ;�JJ �� Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: u C inNit 1-vo TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET !021 t I iO4& t J C <br /> Cm( SW► i0rh(J( STATE ' ZIP oz94, <br /> ` OWNER PHONE: ��, "'VVV OWNER EMAIL: <br /> CONTRACTOR NAME: um, Van c2 c PI u m �` (` JT 1 1,Cs <br /> CONTRACTOR ADDRESS: STREET 1/2 Z 13I c • r) C{k 4 U �e <br /> CITY She A oml,tti VVVV���STATE �� 'j ZIP 2 06 3 <br /> • CONTRACTOR PHONE: i �d '- 31 'J/tt2 CONTRACTOR EMAIL: S( J PI` d r6h t /p 1u,hVij)u 1 <br /> CONTRACTOR LICENSE#(REQUIRED): fnvan PT E 3g0 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): '0 <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ..'OTHER(Please Specify) atolYY9tI(‘.) <br /> CONTACT NAME: CONTACT PHONE: '34V` it'2 '3 hI V <br /> wh, G a l I CONTACT EMAIL: o h o <br /> BUILDING PERMIT APPLICATIO <br /> Existing Use of Building: Contract Price of ork:$ \., 0 O <br /> Proposed Use of Building: Heat Source: ❑G. DElectric •:other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ,,Duplex ❑Multi-Family #of Units: ■Commercial ❑Industrial <br /> Type of Project: El New DAddition El Remodel ❑Repair ❑T.I. ❑Sign ...ialprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ', <br /> "n\-e fillAtmi cn - ---T nail" s <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 /> 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 Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER OPPRESSION SYSTEM <br /> Chemical ,.r Water I1 lr) 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.lam 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 with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT M <br /> os- <br /> 4.O <br /> Se <br /> Owner/Authorize gent Signature Date (Revised 9/23/2016) :-- <br />