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PERMIT APPLICATIglik <br /> *4.E77. BUILDINSVIECHANICAL/ PLUMBING /SIG PRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> �RR��GI��SITE��N,�`'?NM�►�QI� y� � ���� . :-,�:..� <br /> PROJECT SITE ADDRESS: /Ito s W filer, /4411 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONT�AC '.INFORMATION <br /> OWNER NAME: (fie. To ys TENANT NAME(If Commercial): 16v 7;y5 <br /> OWNER MAILING ADDRESS: STREET 'I/O (M£dtj 44 c 1 <br /> CITY x44- ( STATE wk ZIP et 61,03 <br /> OWNER PHONE: Z 5_ 356 - 2, 7 26 OWNER EMAIL: <br /> CONTRACTOR NAME: TrAtteltaGyre;cL. <br /> CONTRACTOR ADDRESS: STREET / Z(110 Al L. /7 t,- 5 T <br /> CITY Woode STATE ZIP 1467 Z <br /> CONTRACTOR PHONE: 266 -- 53 g - vem 5 CONTRACTOR EMAIL: (Le,,4..L 1 twee.ar+t.&ill cat I.c tiG'i <br /> CONTRACTOR LICENSE#(REQUIRED): T�V AlIA*1/3 3 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) 6 CI ,T0-1 <br /> CONTACT NAME: CONTACT PHONE: 2,51, - 5,�r- L./o®S <br /> K Cr �11 d 5. t y CONTACT EMAIL: // (/ ' <br /> ge,4I4 Tri rot eLh4.wrtk1 • Coil <br /> % .,,. . BU)ICD�NG§PERMIT=APPLICATION = jj,f 2 <br /> Existing Use of Building: Contract Price of Work:$ I(U/ o Q 0 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 0,C ro <br /> 5- - 7-0A/ <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 /> / NC-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 /> 1 _„��„4RINKLER I SUPPRESSIO,N*iSTEI , <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 w 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 7/. <br /> PERMIT# M (VC tl�. <br /> l 0 ,i 4 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) \'�L <br />