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Y PERMIT APPLICATION <br /> �� BUILDI MECHANICAL I PLUMBING /SIGN.. r RINKLER I DEMOLITION <br /> f"�.a CITY OF EVERETT PERMIT SERV! <br /> "' tr 3200 CEDAR STREET,EVERETT,WA 1,.t32 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE ADDRESS: l PROPERTY TAX#: (:). ' q' Os <br /> LEGAL for new construction: Short hat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER NAME: (-1 6._c-A,.. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STRE!J 9-2-2-o 20} � �") i'3 A <br /> ,. ,,_ cnY oat*,' 'C I'�a�i STATE -$ ..... ',,7Jz I \ �� <br /> ��NE: OWNER EMAIL: Q, $�J/)@ y.yz tC : CQ y1 <br /> OWNER PHONE: ��� �� -�,t�'S ''' ..t _,_ <br /> CONTRACTOR NAME: . Gciw�GCs ©""ive; <br /> CONTRACTOR ADDRESS: STREET g,2-2-0 1:3 al` 9�4 <br /> CITY ��--Lx-ikek-K <br /> STATE V-J-f zIP ..g).-(;)3 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): V CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: '`-OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: w-"" CONTACT PHONE: t.034; . �� LC,(0 S <br /> '4.4,---‘2): C- `,(C�. - CONTACT EMAIL: .---DS{�y,1�,U-.j lam'ti Y J,�.,C7 -�--1.w%- <br /> -BU1.)20- C PERMI .APPL[CAT>(_ : .: <br /> Existing Use of Building: ` zi,.. Contract Price of Work:$ `OD"— <br /> Proposed Use of Building: ( �' Heat Source: OGas ❑Electric DOther (s ,.i- <br /> Building Type: ❑SFR-Detached :SFR-Attached ❑Duplex ❑Multi-Family-#of Units: XCommercial [industrial <br /> Type of Project: 1NINew DAddition @Remodel DRepair DT.I. EISign I:Sprinkler I Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> C.,ONSTccj CT New sic g-AC. i_ , 17 6 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> 'MECHANICAL PERf9ftAPPLiIGAllti:O_. - <br /> :.......::0'.:0-#0. Al17C PERM0:APPLI°CA'1'ION <br /> Type of Project: New•_ Addn _Alteration _Repair Type of Project: New _Addn Alteration Repair <br /> #of #of #ofList of Fixtures #of List of Fixtures <br /> List of Fixtures Fixtures List of Fixtures Fixtures Fixtures <br /> Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub ---i 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 I SUPP,RESS101.$7STEM <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.1 am the owner,or 1 am authorized by the owner of this properly to perform the work for which application Is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only <br /> PERMIT#k0 t//�( 1 I (00 <br /> Owner/ rized Agen e <br /> Date (Revised 10/12/2015) <br /> 1 )� <br />