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447-7. PERMIT APPLICATIO BUILDINOECHANICAL 1 PLUMBING /SIGN PRINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: /vim 7©S— '/ / Z2-<' PROPERTY TAX#: c9n�-S 23Gkjy'OIO s' LEGAL for new construction: Short Plat/subdivision Lot No. r (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: rk12y,4 G e2"-Zr TENANT NAME(If Commercial): ' /— 2- OWNER MAILING ADDRESS: STREET / 7ef'5 "' &"' Y '2.< 7-7 CITY 16",51 STATE ZIP JcPZ'C,% OWNER PHONE: /2 - '6 7z. ?Y OWNER EMAIL: CONTRACTOR NAME: C:76Uh CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 0��' 2 V ' ,7s 2,9 CONTACT EMAIL: /f"4 Q BUILDING PERMIT APPLICATION Existing Use of Building: S',�.� Contract Price of Work: $ c'c' c' Proposed Use of Building: - ' 'e ,Heat Source: ,3as ❑Electric ❑Other Building Type: ❑SFR-Detached SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑industrial Type of Project: ❑New ❑Addition El Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: q 40 4/E Q �i-CAB" ' ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures Fixtures A/C—Air Handling Units Heat Pump 2 Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater / Bathtub Urinal Gas Piping Boiler 2 Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeration / Shower Floor Drain / Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas Range Hood Water Heater Other: Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: SPRINKLER/SUPPRESSION SYSTEM iNumber of Heads 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 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 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, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City)of Everett Official Use Only /��► / D / / PERMIT# C-I�lid G C — OD 1 l�i OwnerlAuthoriz nt Signature ( Date ( (� (Revised 9/23/2016)