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PE14MIf APPLICA+10 W <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN / SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257.13810 1 FAX 425-257-8857 1(E)everattc4,,ps@overettwo.gov I volvw.everottwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ( ,?!2 lap, PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(if Commercial): j <br /> OWNER MAILING ADDRESS: SIREET -�4'" 54. <br /> STATE W& ZIP 9,220.1 <br /> OWNER PHONE: ?-2—L3 OWNER EMAIL: <br /> CONTRACTOR NAME: 6-04-, mar ic <br /> CONTRACTOR ADDRESS: S1REE1 3,qfC R, SL E��Z <br /> CITY Acaborn SIATE ZIP <br /> CONTRACTOR PHONE: 1CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): Ce <br /> ()I: IV? ICITY OF EVERETT BUSINESS LICENSE#(REQUIRED):0L((q <br /> PRIMARY CONTACT: DOWNER JRCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ztic— <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: lContract Price of Work: $ <br /> 6.nL <br /> Proposed Use of Building: Heat Source: E]Gas DElectric []Other <br /> Building Type: EISFIR-Detached EISFR-Attached ODuplex El Multi-Fa rnily-4 of Units: ElCommercial DlndLJstrial <br /> T pe of Project: 13New ClAddition DRemodel ORepair EIT.I. OSign OSprinkler ElDerrolition 13ChangeofUse <br /> DESCRIPTION OF WORK: ro o re Move ro o P:A i r-. *'vtS4-a11 ()er <br /> LAY& . � _ k <br /> Mec kav,,ce,I IX F-4se-q&d 1145- ,t 6 0 M'.t 7 11 e c ka.,;cci, / PA,54-e-Ae-4. ?Oyeo'— wu/*44/ <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 /> 4!of List of Fixtures #of List of Fixtures #of List of Fixtures 0 of List of Fixtures <br /> Fixtures Fixtures <br /> A/C—Air Handling Units Fixtures Heat Pump — Fixtures Toilet Backflow Preventer(inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boller 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 IDishwasher 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 /> I i <br /> SPRINKLER / SUPPRESSION SYSTEM <br /> I Number of Heads <br /> ACKNOWLEDGEMENT,/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 therpfrnm. Deviations most first he authorized in writing from the <br /> Building Official before being authorized tinder 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 HCW and 296.2UQA WAC. City of Everett Official Use Only <br /> --./ ' ,1 ) PET�#s� 2-- col <br /> 0LUALWorized "en Signature Date (Revised 1011212015) <br />