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y\ ct(`5 .{tom-- n��SO RMIT APPLICATION <br /> 'ECHANICAL/PLUMBING/SIGN/ 1INKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICE*TrS <br /> / 3200 CEDAR STREET, EVERETT,WA 98201 <br /> IJ (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS I (,` �� SaE PROPERTY TAX#: <br /> LEGAL for new construction: S1Toitf'tSUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: /� <br /> V([t`i j"�('`tC tiro TENANT NAME(If Commercial): , ow s�' <br /> �L��ow Srj,> <br /> � <br /> OWNER MAILING ADDRESS: STREET S <br /> 31�, , It.l,w,1 iS St. <br /> CITY mc a Ytt STATE' '�V Vt al ZIP q S- 2.7'), <br /> OWNER PHONE: Li3S ,s"7(I•cl.'eiL OWNER EMAIL: •L(1 CJc ;LkL (e C 9rv1a ti •C'cJflr <br /> CONTRACTOR NAME: O�,J N 161-- J <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: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT <br /> CONTACT PHONE: Sy-� C' <br /> `�.1���,�1{1� 'LC!C�'� CONTACT EMAIL: �� tr� ��+ 7 c�' '� <br /> 9 e 1 U is is o e 91 c�t.� �t*,t\1 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: CbckVe thvt) -.6prtess0 Heat Source: ❑Gas ❑Electric %Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair DTA. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: I el Ag1,,` C (l re mg ek c rw h res p sc, 61,0,_ i`f LW <br /> i ��C 1-k-m_ to a 1 t C t i-c d tefr aczx C{7vl twc- s a , 'l c,�ctur .i 1 C--u.� <br /> 4, ti. , h/Lii b ice s wi Q..1sY41fl( 1tt c,h -iiiv 4x Ia �t 5 vac r <br /> ASSOCIATED BUILDING BUILDING-PERMIT#(if applicable): S fi{U tUt,Vt. . <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn Alteration Repair Type of Project: New Addn Alteration Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> 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 .,-'✓ <br /> Boiler Lavatory(Wash Basin) ,----- <br /> ,_-- 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 er Hookups Other: Clothe asher Medical Gas <br /> Rang ood W r Heater Other: <br /> Eyzaist Fan ink(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 corn. ' the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> / City of Everett Official Use Only <br /> i ,, _ PERMIT# <br /> � � \i/ \ 1 ` j2/O15 r 1 . i ---ou 4 <br /> Owner/Authorize6Agent Signature , Date (Revised 10/12/2015 <br /> � ,7 <br />