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PERMIT APPLICATION <br /> BUILDII MECHANICAL/ PLUMBING /SIGN RINKLER/ DEMOLITION <br /> "11.04Y/;".""1 CITY OF EVERETT PERMIT SERVICES <br /> Nel03200 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 /> PROJECT SITE INFORMATION <br /> PROJECT,SITE ADDRESS:. <br /> //s;-.2 - Arli,. g'C . 5. <br /> LEGAL for new construction: Short Platbdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: i1, A-/,,,` -y-- <br /> �/ , TENANT NAME(If Commercial): / t � Jm � <br /> ,5 <br /> OWNER MAILING ADDRESS: STREET // 2 /,,, ,; 5`-)/-y V 51 / ' <br /> CITY r...,/,o A, - STATE L�,s ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: r l-„„,,q �L ;,..2.4--- <br /> CONTRACTOR ADDRESS: STREET } 21'70 .3 ,,<:;,._,,,....J. ,,,,j,_,\ / <br /> cryF✓eu--e 9 STATE Lv.:� ZIP ,-- 2j-) / <br /> CONTRACTOR PHONE: Q” — -Sao CONTRACTOR EMAIL: L <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: D OWNER CONTRACTOR D OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: sj 5 - 5.5 0 C) <br /> G`FIS CONTACT EMAIL <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ r_ ei1� <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex DMulti-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: @New ❑Addition DRemodel DRepair DT.I. @Sign @Sprinkler El Demolition DChange of Use <br /> DESCRIPTION OF WORK: <br /> blINe e A.m.() o tai c� <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 /> 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/:`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. 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 Law 18.27 RCW and 296.200A WAC. <br /> - City of Everett Official Use Only <br /> / `-? / �' PERMIT# <br /> I ))1i00 I ' 643 <br /> Owner/Authorized Agelit Signature Date (Revised 10/12/2015) <br /> 171 <br /> 112_, <br />