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PERMIT APPLICATIO <br /> BUILDIN*ECHANICAL / PLUMBING / SIGN PRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> OL (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PR JE�CI SITE ADPR SS; V� E��T PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION 2 <br /> OWNER NAME: NM EVA TENANT NAME(If Commercial):511 k' L 1 c fXF-OJ0 <br /> OWNER MAILING ADDRESS: STREET SSd rV�� <br /> �/)\ �- A5 /e ) <br /> CITY mt)Co v `r 1.9- STATE {�'V zip 9066t <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: L P fA Q Q <br /> CONTRACTOR ADDRESS: STREET 1ww501 Jr- NIJ 'JI GL` ✓ 'V - � � )e <br /> CITY 863 6-7o5 <br /> rte'^M(S" STATE N/7 \ zip <br /> CONTRACTOR PHONE: �(aO ©63 6-7O CONTRACTOR EMAIL: f FO 0 C rtl (+J . co M ry <br /> CONTRACTOR LICENSE#(REQUIRED):C,,0 `CM MG.0&,.V G i, A, CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):0 L� <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �L cj -Soo 6+5`0 <br /> CONTACT EMAIL: 6;ret, C I, A-1 <br /> ,£ BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Q 166 lContract Price of Work: $ ;?)00 <br /> Proposed Use of Building: ©MCE lHeat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex []Multi-Family-#of Units: Xommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition El Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler Xemolition ❑Change of Use <br /> DESCRIPTION OF WORK: FIC/00 �� I ME P 't + �pN i jAtj,S , <br /> ptt� TIOA Fe' IT1. r- <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 #of #of #of <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures List of Fixtures <br /> Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater 1 Refrigeration 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/Bar/Mop/etc.) Other: <br /> SPRINKLER / SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT:1 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 authorizedurVer <br /> any circumstance.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> all c mply with the S to Co tractors La 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> //&) PERMIT#�� <br /> bwner/ uthorized Agent Signature Date (Revised 10/12/2015) <br />