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IIII II''II PERMIT AP PLICATI= <br /> "IP' <br /> i SIL®I /MECHANICAL/ PLUMBING /SIGN /SPRINKLER 1 ®EM®LITI®�I <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 <br /> Ink Only Please) PRJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1100 f RcFi t,. Pi& 1 f 'rr 01 PROPERTY TAX#:00,13757 7 oO 10 I <br /> LEGAL for new construction: Short Plat/subdivision / Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> WNER NAME: Fly AVE„.00 $-KY it pt--M4 TENANT`NAME(If Commercial):&V Pu-itcij s irj <br /> OWNER MAILING ADDRESS: STREET 1(00 Pj�}c�ta"'( - NE., 41-5. D <br /> CITY - STATE (/..)p ZIP 115 a4 <br /> OWNER PHONE:I' j - 331-- 3 3 OWNER EMAIL: „*IwHt-R p2vL..tel.J 40>y f� _ X01,.1 <br /> 'CONTRACTOR NAME: -- c� <br /> li4-0PY1,44 t <br /> CONTRACTOR ADDRESS: STREET 67 3 /a+h S4-. Si 14,A <br /> c-A0 An Newt) LSA 98©30 STATE ZIP <br /> CONTRACTOR PHONE:gjs- 714/,7S)3, CONTRACTOR EMAIL: dol let,n e 4ii.Fpm i ey -v4 4 „oil, <br /> '1 CONTRACTOR LICENSE#(REQUIRED) MO /5"61)F CITY OF EV ETT BUSINESS LICENSE#(REQUIRI D): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) V <br /> CONTACT NAME: CONTACT PHONE: *-3a-i oti l r , 4 (�"' <br /> V b01(. 1 <br /> . <br /> M J 0 (!` id CONTACT EMAIL: 6 v�cdn ete�/'�°<i 1467 C ) tr,�f l�'C'(.4701BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ; Contract Price of Work:$ © CVE2, • - <br /> Proposed Use of Building: Heat Source: ❑Gas 0 Electric ❑Other <br /> Building Type: @SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition @Remodel DRepair DTI. @Sign ❑Sprinkler @Demolition ❑Change of Use <br /> .c pESCRIPTION OF WORK: <br /> 77 fate FF-oOT bco 9,-4.. <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 List of Fixtures #of List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit He Bathtub Uri.- <br /> Gas Piping Boi Lavatory(Wash Basin) %'inking Fountain <br /> Water Heater efrigeration 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 :ar/Mop/etc.) Other: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Chemical or Water I No.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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 1//i)� (zoi-7 PER125 6,L/• �0^ <br /> Owner/Authorized A ent ignature Date (Revised 9/23/201 L <br />