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PERMIT APPLICATION <br /> 41577 BUILDIN JIECHANICAL / PLUMBING /SIGN / INKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 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 /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: PROPERTY TAX#: j ,f`, , <br /> lOI_ int"Air �r ! <br /> LEGAL for new construction: Short Plat/subdivision Lot No (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: T-F'it ,I ._) (.VU'L,.+( fit(, i-n t,-)i.)5 2>` TENANT NAME(If Commercial): ,r ', i Le 4- t5 <br /> OWNER MAILING ADDRESS: STREET 20 ex, 1 7,Cj 3 <br /> yt\'( I@ go-7 <br /> CITY STATE �',,e� ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: iU��-c f 51 qv) 4 Pt Give(-h s, (.1 <br /> CONTRACTOR ADDRESS: STREET Zip Occ I1-+'-1,x\1 c(c/ 5. <br /> CITY W(AAA't" l VVV i tCAC{\ STATE (if/ ZIP 9 ��,7 3 <br /> CONTRACTOR PHONE:3(,e ) -L�),.,( -1 , � \ CONTRACTOR EMAIL: S.+-C.(`-4(1 i e 6jry, nr51 ave . Cuer <br /> CONTRACTOR LICENSE#(REQUIRED):r&1i•-1 (j 7,4 b e CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):LS3 ) S 9 <br /> PRIMARY CONTACT: 0 OWNER EJ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: U .`i Zc( t 3„S <br /> )-`-t?--(1' 6e LAn((qUt15A CONTACT EMAIL: ct-e-..anIe�wr4c4f't'Sl ,ih C(i<Yl <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ Z, O(,);',; <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ESFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition CI Remodel ❑Repair ❑T.I. QSign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: `11 Sfi„i(ii' •; On-( fl _.) kry n a*e cj tAjo 1 5 I ;h- <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 #of #of <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of 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 oflEverett OOfficial/Use <br /> �s of Only <br /> ` � Z Zz ' PERMIT#t J 1 lCl l,'l�- l)`L 1 <br /> Owner/Authorized Agent�ignature I Date / rr (Revised 10/12/2015) <br /> IP_ <br />