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PERMIT APPLICATIO <br /> 477- BUILDINI ECHANICAL / PLUMBING / SIGN i RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 9'2I Wcat ` f PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 1,Ajni vii 1110 TENANT NAME (If Commercial): <br /> OWNER MAILING ADDRESS: STREET Cl A wa S'r- <br /> CITY 0`' STATE W ZI c)-(, <br /> OWNER PHONE: ' -� �j� � <br /> ) L �3 OWNER EMAIL: 1 \ <br /> "C: Wt(ki�k,01'1,MCti( L. can--k„ <br /> CONTRACTOR NAME <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED):#( CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: VOWNER ❑ CONTRACTOR LI OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4�s_ 3,P- --'-1 E 8 <br /> I'I W I,\ kA11(`--5 CONTACT EMAIL: `\,,Z <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: (v.,(cle, Contract Price of Work: $ <br /> Proposed Use of Building: 4-(�M¢ (cg) Heat Source: IldGas 171 Electric ❑Other4ii,/\ f l 1 bo <br /> Building Type: a6FR-Detached ❑SFR-Attached 171 Duplex ❑Multi-Family-#of Units: El Commercial ❑Industrial <br /> Type of Project: El New ❑Addition ❑Remodel ❑Repair LIT.I. OSign ❑Sprinkler I=1 Demolition ❑Change of Use <br /> DESCRIPTION OF WOR • h./6 \ <br /> /„I„ -=... ''' _ —01 n ' <br /> ova oil .0AL ( Aakiimpli .) \..(\d' +lit_ <br /> ASSOC ATED 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 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 ShowerFloor Drain <br /> _ _ <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 /> I J City of Everett Official Use Only <br /> C�vI PERMIT#(� (rO�_ O1 �(Z.Owner/A011) AYI <br /> orized Agent Signature Dae (Revised5/20/2016) V <br />