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PERMIT APPLICATION <br /> BUILDIN -J1ECHANICAL/ PLUMBING / SIGI RINKLER/ DEMOLITION <br /> A CITY OF EVERETT PERMIT SERVlai1 <br /> Noilidai <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 Ink Only Please) PROJECT SITE INFORMATION <br /> (PROJECT SITE ADDRESS: 37/ 3 A(S2 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Alf-C44( `// .7 l o TENANT NAME(If Commercial): 1�6ZC YZ ilo /Zf�GE"7L <br /> OWNER MAILING ADDRESS: STREET t!��«— <br /> CITY ` STATE ZIP <br /> NER PHONE: y�5 2 5-0 / OWNER EMAIL: .. <br /> /CONTRACTOR NAME: 15/441 L�iS ' N6-PuL€il /O/ll( 1.....1..-6- <br /> CONTRACTOR ADDRESS: STREET 7/y /�/r Sr• dig_ <br /> CITY ��7�- �j(� OT! � � STATE �jt/ .2 ZIP / g/j'a <br /> CONTRACTOR PHONE: Drj=(�, 'j23 - Z�Z�j CONTRACTOR EMAIL: (��j// 2�1s 6 7#(� jTU0 <br /> CONTRACTOR LICENSE#(REQUIRED):3,,}tk t W O Di) CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 05-5-1110 <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR 0 OTHER(Please Specify) �1 <br /> CONTACT NAME: CONTACT PHONE: 5ev- (e - 2 ZS <br /> �c)a3Gglkz. , ',P44/4- .lj CONTACT EMAIL: (2 L S t7,412.44:.,5-.. g C7/ /4U,,C-0Gk <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$_24) <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached DSFR-Attached ❑Duplex ❑Multi-Family-#of Units: II$Commercial ❑Industrial <br /> Type of Project: ❑New DAddition 0 Remodel ❑Repair 'RIT.I. ❑Sign ❑Sprinkler El Demolition ❑Change of Use <br /> /DESCRIPTION OF WORK: <br /> -ui; u/ A 1 gl4' /;off OSY <br /> ASSOC! , t N PER IT#(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 Fixtures List of 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 Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> 54, Clothes Dryer Hookups j 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.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.1 am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State ontractor•"aw 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> L `/ - 2C� i (ton7-051v <br /> O' _ <br /> er/Au orized Ag: t Si.nature rate (Revised 5/20/2016) <br />