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02/18/'2016 15: 06 4254868102 ROCK ROOFING PAGE 01101 <br /> PERMIT APPLICATION <br /> BUILDING 1 MECHANICAL,/ PLUMBING /SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> -- (P)425-257-8810 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa,gov/permits <br /> PL� � RMAb r; <br /> l <br /> PROJECITEA <br /> ` PROPERTY TAX#: <br /> LEGAL for now construction: Short Plat/subdivi ion Lot No. (attach copy of long legal description) <br /> i <br /> " . ;. <br /> cONtAd IN1= a 1 <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2 <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: gock kz"N <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE (5 1 <br /> 4 nv <br /> CONTRACTOR PHONE: 47-f— 41eb—,131,33 CONTRACTOR EMAIL; f� <br /> CONTRACTOR LICENSE#(REQUIRED) T© it SZ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)_ <br /> CONTRACTOR ❑ OTHER(Please Spec <br /> PRIMARY CONTACT: ❑OWNER jfy) <br /> CONTACT NAME: CONTACT PHONE: tlZj <br /> ISMKCONTACT EMAIL: <br /> Mu1.>. ., i,,:B.lLILGi�IG,� � •.�E1P.P�`f. q�'0.111 ::', i ;,4 ;».. .,Miwr:�. <br /> Exisling Use of Building: Contract Price of Work' ou <br /> o/ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: SFR-Detached USFR-Attached ❑Du lex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> T pe of Pro ect: ❑New ❑Addition ❑Remodel ❑Re air ❑T.I. ❑Sin ❑S rjnklor ❑Demolftlon ❑Change of Use <br /> DESCRIPTION OF WORK: )� <br /> rfmvY121 <br /> ASSOCIATED BUILDING PERMIT# if a lice ble : <br /> me, hAN1�rA� ��r211�1 7 I►P�LI'CpTION 4LIJNfP�>("IV f`, nl vP.p, �.� 1 <br /> N <br /> Type of Project: New Addn ­Alteration Repair Type of Project. _New --_Addn ,Alteration Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures L/st of Fixtures 9 of Fixtures Oxt of oixfures <br /> AIC—Air Handling Units Heat Puma Tollet 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 Mange Ductin Dishwasher Roof Oraina <br /> Clothes Dryer Hooku s Other: Clothes Washer Medical Gas <br /> Ran a Hood Water Heater Other: <br /> Exhaust Fan Sink(ServicefBar/Mop/etc. Other: <br /> PR <br /> • IDLER P$ Pip!:) �S.'31g111'"SYSTEM <br /> $ <br /> Number of Heads <br /> ACKNOwl-EOGEIVENT;I have reviewed this application and confirm the informstion contained herein is true and corset. Work done pursuant to tills permit must Comply with <br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviatlons therefrom.Devlationa must first be authorized in writing from the <br /> Sullding Official before being authorized under any circumstance.I am the owner,or I am outhorizod by the owner of this property to perform the work for which application is made, <br /> and I comply w/th the State Contractors Lew 98.27 ROW and 296,200A WRC. <br /> City of Everett Official Uw Only <br /> PERMIT#, <br /> 1 <br /> -Owner/AuthorIzAd Agent Signature Da a (Revised 70/1 015) _ <br />