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47- PERMIT APPLICATION <br /> BUILDIN(-__ -CHANICAL / PLUMBING / SIGN 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: 111/0 f l"ITL h 1>I S� I r e1'c l-t eroLos 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 ho&4 A. 5rt Q f TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET )1 O l qj IPI <br /> rife/VI- SI- q <br /> CITY T STATE WA ZIP 1 <br /> OWNER PHONE: nOWNE,R EMAIL/:p A ,> <br /> CONTRACTOR NAME: 4i rermuft°.�"'J Ll �- `7 A IIPtlnw evorici r7 IVaf{4 P-ujt4- .S0u <br /> CONTRACTOR ADDRESS: STREET// -_1.J-�/o 7 Moe: 1e S,i eecIW,ti /55 <br /> CITY t/V 1n/� cif / �J STATE 0" ZIP y$oy7 <br /> CONTRACTOR PHONE: ya5 Fj'Ojp jCONTRACTOR EMAIL: ndfi-k ciLl'Sovfld wftIrvvvvue d•c©.. <br /> CONTRACTOR LICENSE#(REQUIRED): W I kiPo JN x531_ ( CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 055 7o0 <br /> PRIMARY CONTACT: ❑ OWNER i1 CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAMEA CONTACT PHONE: 1��5_)i,5.01 p I <br /> aPe)1 c tem./ CONTACT EMAIL: <) <br /> BUILDING PERMIT APPLICATION �J <br /> Existing Use of Building: ee,5'lcif 4-4;g ( Contract Price of Work:$ 0),(104 <br /> Proposed Use of Building: 1 -toS'd .40) I Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: IgSFR-Detached DSFR-Attached 0 Duplex ❑Multi-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: ❑New ['Addition IMRemodel DRepair ❑T.l. ❑Sign ['Sprinkler 0 Demolition ['Change of Use <br /> DESCRIPTION OF WORK: KeMove. f)c•Sf :30',1(6 )uA bvMdvw, rc ( j 5-0467 n x w4i, ftfr he,4eJ <br /> (A54AI1 newa nct4c/1 WI`1121A/ VMY) N��h I"1,1 /0w)eckoN ,A(,� 7'IrtI'(,Q �al�in i/4ST'(115 `Ov1 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): J <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 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 authorize•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 Contra.ors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> ; �� 131 (oO 3c? <br /> c*�r/Authorized Agent Signature Date (Revised 5/20/2016) <br />