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• PERMIT APPLICATION <br /> ..,,, BUILDII` MECHANICAL/ PLUMBING I SIGN RINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICLU <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 /> : . <br /> : _: -::::., ,.:...riPRO.1EGT SITE INFORMAT10N . ;. ,, . : . . . <br /> PROJECT SITE ADDRESS: 3 p p/ Ho yr PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ...._ . .: . ,, .::CONTACT INFORMATI'O0 <br /> OWNER NAME: Gv re v6%, ( cTENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREEr 3/0/ — /1(cY 1 fr v'e_ G�'(J <br /> FVe lf CITY W4 STATE ZIP / () 20/ <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: ON 1lai S/T1 ,4 <br /> / 1•eck n, ' / <br /> CONTRACTOR ADDRESS: STREET (1b // I1'41 PG Wen /.Q <br /> 0• s, ''X 6 7 �l <br /> CITY M(IN/L(6o STATE W� / ZIP q Z,z <br /> CONTRACTOR PHONE: 206 - 3 64 - `J g/o CONTRACTOR EMAIL: rfr"e�t Cts V umc i. Cow <br /> CONTRACTOR LICENSE#(REQUIRED): ON I YM C- Pi 3N 1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):CO 072 <br /> PRIMARY CONTACT: O OWNER lel CONTRACTOR O OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> Lt l i=',• f;Qwl',,ti't CONTACT EMAIL: <br /> BUILiDiNCPERMIT APPLICATION':: ;d. ._ <br /> Existing Use of Building: ,. ., Contract Price of Work:$ 114 0 <br /> Proposed Use of Building: Heat Source: CIGas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: OCommercial ❑Industrial <br /> Type of Project: ONew DAddition ORemodel DRepair OT.I. OSign OSprinkler ClDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): y,-) ( 5 VI- D )--t <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:!SUPPRESION:SYSTEM`. .: <br /> Number of Heads <br /> ACKNOWLEDGEMENT 1 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 em 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 /> City of Everett Official Use Only <br /> W'-' ' ,9 a'V / PERMIT#0 ( 0, _ voLA <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />