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1 <br /> eir .w. PERMIT APPLICATIp9 <br /> o... BUILDII— MECHANICAL/ PLUMBING / SIGPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> �a 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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> ii <br /> PROJECT SITE ADDRESS: 7 f C a S t L' (`t-® ' E is f <br /> �O �_ H• CV .7 yd,oy PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): - l/1_,,7 L '! i A.:_, `a / <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE Z P <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: fi E- ((pc_ -ketz,~rt)mrd f.2 /L.-OS G 4 til (p N E S er£-I'4.A <br /> • <br /> CONTRACTOR ADDRESS: STREET a-at- - C 451 eO (td . 5$cis`{t) r <br /> CITY 2 U E'V E1 ` ST/.(`ATE L(.) 6. ZIP 5 8? <br /> CONTRACTOR PHONE: (C b) q31- (-f�- 3 g' C2t-1 CONTRACTOR EMAIL:4*./ f 0.I(/9 C 44 y pi`9 ticl iZ CALtvt'(:c( <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR p OTHER(Please Specify)'Te .-i'4 - <br /> CONTACT NAME: CONTACT PHONE:(.7G G) q9/- c/ <br /> itiyi£ (Z..AJA ^ide2 CONTACT EMAIL: Q(/ q4al(.( ciyi✓A/JdFz_ c-L.iiJ[ ,CcDA( <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: a{` z ,Shur Contract Price of Work:$ 3.000 <br /> Proposed Use of Building:-►20.R, f/00Al ✓t11"44-SitYT- Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: USER-Detached ❑SFR Attached ❑Duplex ❑Multi-Family-#of Units: gCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair WT.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ,12 t rpt o U^4 mac !S E,c y t6.j�Y'e o-i , 0. p `,1 [ d GL €. Q. '�-pcES-v„ <br /> CI).- at r4t'u' f(°, .1- r4 t'sr r <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 #of <br /> List of Fixtures #of List of Fixtures #of List of Fixtures List of Fixtures <br />/ Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump L----- Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler fm' 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.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> F—' ,..../.2 4 le-c_e__.324.- i' <br /> PERMIT.# r- <br /> ' <br /> Owner/Autho ized Agent Signature Date (Revised 5/20/2016) CI(joto D..e3 <br />