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PERMIT APPLICATION <br /> BUILDINCHANICAL/PLUMBING /SIGN 1,RINKLER/ DEMOLITION <br /> /111P-— CITY OF EVERETT PERMIT SERVIC <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION' <br /> PROJECT SITE ADDRESS: <br /> tan Assa4 4-i <br /> A.... i mid/ PERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION'''' <br /> OWNER NAME: eit,dyi-z, miti4-04...., TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET LP i DI -/" ...<'te,M--‘...16 I _514 4111V <br /> CITY iv44,,,{4.4— STATE Lik...)Vi ZIP 91>Z13 <br /> OWNER PHONE: L- i C 7711 1-11,-/c, OWNER EMAIL: <br /> CONTRACTOR NAME: 11,//14.1 . .711..0. g4.1-jcS kilt/ <br /> CONTRACTOR ADDRESS: STREET 71-10,1) -.4.14,14.64-tik or/ <br /> Cm, &vet/6++ STATE LAM ZIP getv2.03 <br /> CONTRACTOR PHONE: LI is"77i,f-fiSS—x--ii / CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED):ige1/1/16Sk-5-767 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):Z14781, <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NARE: CONTACT PHONE: LI Z c—nti, ge6-5S- )(..... hf 1.1 <br /> filit&I`C Slat-5 CONTACT EMAILthwi Ls e 1,..„7,7,1 esj 914.55Skilt-S e-0A---/ <br /> • BUILDING PERMIT APPLICATION • • <br /> Existing Use of Building: Contract Price of Work:$ /Z / 5-5L CP--/ <br /> Proposed Use of Building: Heat Source: El Gas ElElectrik DOther <br /> Building Type: EISFR-Detached EISFR-Attached ODuplex OMulti-Family-#of Units: , Commercial ID ndustrial <br /> Type of Project: ElNew OAddition El Remodel EIRepair CIT.'. EISign OSprinkler I:Demolition EIChange of Use <br /> DESCRIPTION OF WORK: <br /> •tr\ +7L1,1 NV-- Lo" °CIU ' 1P\ (ti+-) <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 #of # of <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtlires Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> orced Air Systems Unit Heater Bathtub Urinal <br /> Piping <br /> a <br /> a <br /> Boiler <br /> Refrigeration <br /> Wood Stove <br /> Ducting <br /> Other: <br /> 1 <br /> INKLER/SUPPRESSION SYSTEM <br /> Lavatory(Wash Basin) <br /> Shower <br /> Kitchen Sink&Disposal <br /> Dishwasher <br /> Clothes Washer <br /> Water Heater <br /> Sink(Service/Bar/Mop/etc.) Drinking Fountain <br /> ter Heater <br /> Floor Drain <br /> as Fireplace <br /> Grease Trap <br /> as Range <br /> Roof Drains <br /> lothes Dryer Hookups <br /> Medical Gas <br /> ange Hood <br /> Other: <br /> haust Fan <br /> Other: <br /> SP <br /> !Number 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT#7eiit...V <br /> 3itilit,e Sie03— Oc) I <br /> 4 i <br /> 0 r/ uthor d Agent Signature Date (Revised 10/12/2015) <br /> I <br /> I \ <br />