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PERMIT APPLICATIO <br /> BUILDI MECHANICAL/ PLUMBING /SIGN RINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 J FAX 425-257-8857 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: <p t ii # '3� PROPERTY TAX#: Si q ooSc 9 O <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION r l <br /> OWNER NAME: L '&O PLr-j 4 Vj LL.CIENANT NAME(If Commercial): cP�L ilp4jg <br /> OWNER MAILING ADDRESS: STREET 7 4 S 2- sj; So 1 Tom' t _ <br /> on1' J(• STATE ZIP <br /> OWNER PHONE: �, t - Q Z� OWNER EMi .L . <br /> IL: TV it PkT 1 rh'R . .C'D/1/'� <br /> CONTRACTOR NAME: S1 \)C'T) R . _CONTCTORADDRESS: STREET7q2 c7id rYSSTATEZIPa - <br /> CONTCTORPHONE: 2 - 2 [ � :� CONTCTR EMAIL: ()J1 � i.66 <br /> CONTRACTOR LICENSE REQUIRED: CITY OF EVERETT BU ESS LI ENSE REQUIRED <br /> � > Rt�r�15 , 3 <br /> �c � 561 <br /> b Z- <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: C ZST-2( � ���� <br /> Cz � � CONTACT EMAIL: 1 `taw `�, .C rV <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ �fC�� <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: �Nsr�r1,�. \ �, �w M Vc*(a-UQ f1cwte <br /> ) <br /> ASSOCIATED BUILDING PERMIT#(if applicable): Aj4 f U S t�+�S f Ss'\AAtL.- v '� <br /> MECHANICAL PERMIT APPLICATION �UMBIN PERMIT APPLICATION <br /> Type of Project: _New- Addn Alteration _Repair Typ Project: w __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 /> A/C—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 'oof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer -,'cal Gas <br /> Range Hood Water Heater [ Othe).,,44 i f jkpioile. <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) -Oth= _ <br /> SPRINKLER/SUPPRESSION SYSTEM e f, I ii.,,iiiiri . ii P Lp <br /> k*) yj v ' �r� i <br /> 1104.41 <br /> Chemical or Water I No.of Heads <br /> ` <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 1 comply with the Sta ntracto aw 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> < p --•-Z PERMI #n D ool <br /> 2 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />