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PERMIT <br /> IBUILDIN"ECHANICAL I PLUMPING I SI=31RINFCI.E / DEMOC„ TION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8867 l(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> ff <br /> �1 'IluuCs gnllj%10( s0) 1PII�OI�9Tt ADDRESS: �fji ZD 'G��� PROPHRTYTAX#: <br /> onstruction: Short Plat/subd(vlslon Lot No. (attach dopy of long legal description) <br /> OWNER NAME: AA04yze;,w TENANT NAME(if Comn-tercial): <br /> OWNER MAILING ADDRESS: STREET (t��?j�� I/ <br /> CINE STATE ZIP �U <br /> OWNER PHONE, 4Zs;-) Z "-o — OWNER EMAIL: <br /> CONTRACTOR NAME:^L:l?�=-•t �� A& <br /> CONTRACTOR ADDRESS: STREET al,7_0 A-Cs`t-(_L <br /> Cpy W STATE WA ZIP <br /> CONTRACTOR PHONE: (L�25) 252~ ;5((4- CONTRACTOR EMAIL; C:�j M <br /> CONTRACTOR LICENSE#(REQUIRED): .Vi(; CITY OP 1 VERBTT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ~CONTRACTOR M ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (q—Z-5) <br /> CONTACT EMAIL: V-,P—+� g e�S1y� �` lyl <br /> . . . .... :•. .: .. ' " :'BIJ,ILD-IiVt9.P�FtlY11`P:APE?I:I�J�,'T[®h� . . <br /> Existing Use of Building: Contract Price of Work:$. <br /> Proposed Use of Building: Heat Source: l681s ❑Electric ClOther <br /> Building Type: EISFR-Detached ❑SFR Attached uplex ~ iulti-Family-#of-Units:--- ❑Commercial ❑Industrial <br /> Type of Project: ❑New ElAddition DRemodel ❑Repair CITJ. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT# if applicable <br /> I <br /> PLUM �lE��q fl':�PE��1(��� <br /> Type of Project: ___,New _ Addn Aiteraflon ,Repair Type of Project: ,New Addn Alteratlon ,JRepair <br /> #of List of.Fixtures #of List of Fixtures #of .List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Neat Pump Toilet Backfjow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> #Gas <br /> r Heater Refrigeration Shower Floor Drain <br /> ireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> ange 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 /> =•.�; ; � i�9} 1L�1 •% ►IPIW [ 8®jill;�� Ti~,�Fl,. . : <br /> Number of Heads <br /> ACKNOWLEDGEMENT 1 have reviewed this appllcation 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 f/rstbe authorized In wdiing from the <br /> Bui/ding Officlat before being authorized under any c/rcumstance.I am the owner,orl am authorized by the owner of this property to perform the work for which appllcation Is made, <br /> and/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Okla/Use Only <br /> PERMIT# . <br /> 9,L, c X14 ��=Z �7 D - 00� -_ <br /> lwner/AUthorized Agent Signature Date (Revised 5/2012016) <br />