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PERMIT APPLICATION <br /> BUILDIN44-16IECHANICAL/ PLUMBING /SIG PRINKLER I DEMOLITION <br /> ,••••$.11 .0 .,....A___ <br /> 017 <br /> vit CITY OF EVERETT PERMIT SERV- <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 ON <br /> f PROJECT SITE ADDRESS: —) v(J t�p�(l PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision j� Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION .•. . <br /> OWNER NAME: P - ,\ C --- {'c TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET \(1(\Q <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: WAY()\>,,X_ C \ Cif ,U-- <br /> CONTRACTOR <br /> U_CONTRACTOR ADDRESS: STREET 6 0 AUX 'R oU \ 9 c5 ' _ <br /> \` Cre.e._k_" CITY >e STATE lam-_� ZIP CI) /45‘ <br /> CONTRACTOR PHONE: LA Ls 1 -0 I, CONTRACTOR EMAIL: OL.kilo t..ty...\\ 1, .0...Q3(Y) <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): I ae <br /> PRIMARY CONTACT: g,OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: �\,--v e\` L\ (5 I( t AI k CONTACT PHONE: U Z,5 LO\ Z!( 3j <br /> CONTACT EMAIL: LA_ l-{-rclL( '�,a)-p \, ` 0('sl <br /> BUILDING PERMIT APPLICATION . <br /> Existing Use of Building: Contract Price of Work:$ V\Vul.. <br /> Proposed Use of Building: Heat Source: DGas ❑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: <br /> Yew <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 /> 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 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/.SUPPRESSION SYSTEM;: ,,:: <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 /> �Ciitty of Everett Official Use Only <br /> C--- ) 'Cil <br /> 1 + ( PERMIT#.Y 01)(4.-- 01 <br /> / `� l O l rC 4 <br /> Owner/Authorized Agent Si nat re Date (Revised 10/12/2015 <br />