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ATI <br /> BUILD= MECHANICALS PLLUMBiNG/AlliP,"/—_,—A PRMITCSI r f •►PRINKLER/ DEMOLITION <br /> •1011 CITY OF EVERETT PERMIT SER <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 /> ,GG PRO070- ITE,iNFORMATION <br /> �w <br /> PROJECT SITE ADD S: � '" PROPERTY TAX#: t1 "l W 0 00�� <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACTINFORMATION <br /> OWNER NAME: U fAN 6R(/I IZ.12V)- 1L '--l 0' (C, TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET Ft) -00 K 1-1Cec, <br /> CITY 1iU00P I/4 V 1 I,(, tAlk STATE 9eb72- ZIP <br /> OWNER PHONE: 1'f-7,5,... 10-'7-- --:,,3 ( OWNER EMAIL: (aV/94/11 1j a l irYe"1(!V-(il✓1'I A if „ <br /> CONTRACTOR NAME: ry 0 (/ cj�(.,I. p.I2 gI✓ 14-11b LL-11b L-1-6— l <br /> cl <br /> CONTRACTOR ADDRESS: STREET L ( ��� <br /> cITY tP©°(t N. ( I L.-LC STATE W/'i ZIP 9c7 <br /> CONTRACTOR PHONE: t-t' ✓ ' ((0, `-2-923 7 CONTRACTOR EMAIL: LA ria4r)601LA 1 Vire I L-LC€ �NIG�/i,,toG� <br /> CONTRACTOR LICENSE#(REQUIRED): UQQl�l.� ti`s5 CJ 2- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ! `'! <br /> PRIMARY CONTACT: 0 OWNER *CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4--7--C. ,S t� ' -2-33 z <br /> 9E1 7(6 CEt .ECS1`tD CONTACTEMAIL: urL 51u1 Ire( U2 C iltMg1( ,C-DW1 <br /> 7,. <br /> -: _ _; ,BUILDING PERMIT APP.LiCATION-- '." .�. ..: . . . .. ... . - -. <br /> Existing Use of Building: 6f Contract Price of Work:$ <br /> Proposed Use of Building: '- F-- Heat Source: jirGas ❑Electric ❑Other <br /> Building Type: SFR-Detached ❑SFR Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial 0 Industrial <br /> Type of Project: ❑New ❑Addition ORemodel ❑Repair OT.I. ❑Sign ❑Sprinkler DDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: kf7te..D x..t6-t-I l.1 e V('G-f-t ( ( Fb►e- HIV/G <br /> ? k-- VI 0(..'` Ec- 1,4 �1`-(S`.-AGas Ii3A- O\SE <br /> ValkINLS - 012 '7Uf--- ;L.D 1-0 1t\, k-itio 112-. rti- 1)129A-16 F°(11)1?-e6. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> :.:-•-_.:MECHANiOAlt#011 .0 APPiLI0-4# N PLUMBING.PERM IT;:APPLIGATION <, :, , <br /> Type of Project: New _ Addn Alteration Repair Type of Project: New Addn ,.,Alteration Repair <br /> #of List of Fixtures #of List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump .' Toilet Backflow Preventer(Inside Bldg) <br /> 1 Forced Air Systems Unit Heater I Bathtub Urinal <br /> Gas Piping Boiler '[- Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration 2- 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: j Clothes Washer Medical Gas <br /> Range Hood ( Water Heater Other: <br /> Exhaust Fan t Sink(Service/Bar/Mop/etc.) Other: <br /> ,SPRINKLER:I SUPPRESSION SYSTEM. :,:-: <br /> Number of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is Live 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 the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett OfficiallUse Only <br /> 10 ' / if '/ // / Li/5! l PERMIT# <br /> P(o04-10e12, <br /> Owner/Authorized Agen Signature Date (Revised 10/12/2015) <br />