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PERMIT APPLICATION <br /> BUILDI (MECHANICAL I PLUMBING I SI i t SPRINKLER/ DEMOLITION <br /> I I CITY OF EVERETT PERMIT SER "" <br /> iiiiy <br /> ; 3 3200 CEDAR STREET,EVERETT, �."01 <br /> _ <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> ( 04:0 ?i. i-.16ck 110k *0113/' Illes�) 04.00 0* TIMTIVO'i-7_i9i4t00 <br /> , ROJECT SITE ADDRESS: LZO Ti 6(�C.)Ci�`sJd�y" PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision ` Lot No. (attach copy of long legal description) <br /> CONTACT INFO RMATION <br /> --DOWNER NAME: 6 c (4_00t�J� LLC. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET \ (p\1 I,.,fi� �J NJ, N <br /> )e'.' 1 AO <br /> cirY l { . i STATE � A ZIP 9 1�V, <br /> OWNER PHONE: i OWNER EMAIL: <br /> .. CONTRACTOR NAME:._. ....G ILe P..... ' \eon.._..... ....nV ,V,►.A V3(A.'... . ..:S ; ,v` ._.. . .., .. ..... ._ k.., a .. .. .. <br /> CONTRACTOR ADDRESS: STREET (6(0 L V & *± (Q (.01) ( S c"---) <br /> ary S e,00 L.Q, STATE ZIP etrC) — <br /> CONTRACTOR PHONE: t ZOO 937- 1 Z Z O CONTRACTOR EMAIL: � <br /> , JJ <br /> ;,. , C Lc.,o.,n tDI(0.V M 'M.A <br /> CONTRACTOR LICENSE#(REQUIRED): ( e 0 f y Q 7U e +1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED).. Y <br /> r ,'o�tg\-A.nm <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) --\\' DS�j t <br /> CONTACT NAME: CONTACT PHONE: <br /> ir <br /> CONTACT EMAIL: <br /> .-:1 . .. -. _; : % - BUILDING-PERMIT.:APPLICATION _ <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR Attached 0 Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial — <br /> Type of Project ❑New ❑Addition El Remodel El Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use — <br /> DESppCRIPTION OF WORK: 1Uh/�1p V‘. flv�CkA biLc Qio e c e : (Z..wck c- A_L <br /> C..O,C(ll (1-‘ 5 1 j1/4).1_ K. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION '—taU.AIIBERMIT APPLICATION _ <br /> Type of Project: _New _ Addn Alteration _Repair Type of Project: _N w _Addn _Alteration _Repair <br /> #of List of Fixtures List 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 1 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler 1 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 1 Water Heater Other.4-160 il 51,131-5-If <br /> Exhaust Fan 3 Sink(Service/Bar/Mop/etc.) Other. <br /> -- SPRINKLER/SUPPRESSIONSY"STEMVI :..- <br /> Number of Heads <br /> ACKNOWLEDGEMENT:/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.tam the owner,or!am authorized by the owner of this property to perform the work for which application is made, <br /> and f comply with the State Contractors Law 18.27 RCW and 296.200A WAC <br /> - <br /> City�of Everett Official Use Only <br /> C .--1 ) \....I`------,----- <br /> 7 ` q1PERMIT} 1 10 o� O01�fl <br /> Owne/Authorized Agent Signature Date (Revised 5/20/2016) . <br />