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PERMIT APPLICATION <br /> BUILDINOMECHANICAL/ PLUMBING/SIGN RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICE <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1- FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> _ •::_..,PROJECT:$fTE INFORMATION:'- _ <br /> PROJECT SITE ADDRESS: ,?67'D (� j f= PROPERTY TAX#: OO��7 3 Z o d 300 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER NAME: 1 rs cJTE-A/56A/TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 5-70 <br /> 70 7 6 A()C-- A)C: Qom+ <br /> CITY I� 10�f 1 S J : (-P- STATE w!VJ�1 Zip ` 8 Z 70 <br /> OWNER PHONE: .ZO(c-ZS/- 17c r OWNER EMAIL: 3e-(T- 2G /& ' h 17- <br /> . <br /> CONTRACTOR NAME: S e / - E b l e C�J-1 e r / s e s /I c <br /> CONTRACTOR ADDRESS: STREET 57 7 C,--1/ a pr <br /> My �y i Gl f� I t r STATE LU YT ZIP "( �Z 7 <br /> CONTRACTOR PHONE: ZU(o z S!-%7o S- CON TRACTOR EMAIL: y-4? <br /> TY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR LICENSE#(REQUIRED). I <br /> PRIMARY CONTACT: ;KOWNER 0 CONTRACTOR ❑ OTHER(Please Specify) a T <br /> CONTACT NAME: CONTACT PHONE: 2 C)(Q- Z3-/- 17c S <br /> CONTACT EMAIL: <br /> " '..BUILDINCy_.PEP MITAPPLICATION <br /> E)dsting Use of Building: ��5 i GI e v �0.I Contract Price of Work:$ <br /> Proposed Use of Building: (Z-5i C:-"V =0. Heat Source: ❑Gas RElectic []Other <br /> Building Type: SFR-Detached ❑SFR Attached []Duplex E]Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: []New DAddition �emodel ❑Repair ❑T.I. []Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: S}�(/ f T <br /> ,Jew ���s rc� I � �ov t <br /> loasemna•� k wt 2 o f oc.vis. �cav•.rdr' d f- l�ouv�1• JfAJ la r-ge wlelS: bd. C/v <br /> 2eW,�J�`{ ��tr15 �7� rte+ P(v'r to opzti J� spcxcIe (LSP_ IRI�p�,+�exts���lc�:k +�u' <br /> eKPcvf=�c�?C�Cw.tt�S�XtG'.i G�cb 'trN P-eec,r ��nJ i eS' + cidd -QJv,C .�C �,rc,4 yc6-A . D <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> MECHANICAL,PERMIT APPLICATION P,.LUMBING PER . MAPPLICATION <br /> Type of Project: _New Addn Alteration _Repair Type of Project: _New Addn Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures <br /> Fixtures List of Fixtures Fixtures List of Fixtures FL a es Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet V1W Backflow Preventer(Inside Bldg) <br /> Forced Air Systems 6 Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin)Al Drinking Fountain <br /> Water Heater Refrigeration Shower tri Floor Drain <br /> Gas Fireplace Wood Stove t( Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher w tW Roof Drains <br /> Clothes Dryer Hookups Oth r. Clothes Washer Medical Gas <br /> Range Hood I M=:vR 2 5� E ✓Nd [_I:—. <br /> Other: <br /> Exhaust Fan t,;J heck cps Sink(Service/Bar/Mop/etc.) Other. <br /> "SPRINKLER/.,SU,PPRE$$IQN SYSTEM_:. , , :, <br /> Number of Heads <br /> ACKNOWLEDGEMENT:l 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 l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Y/Z (OL <br /> 0wner! u r ed A ent Signature Date (Revised 10/1212015) <br />