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BUILDING ( MECHANICAL/ PLUMBING I SIGN I SPRINKLER/ DEMOLITION <br /> 71477 CITY OF EVERETT PERMIT SERVICE <br /> 3200 CEDAR STREET,EVERETT,WA 9E <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE-INFORMATION <br /> PROJECT SITE ADDRESS: PROPERTY TAX#: <br /> 5 4/j A,610:111EEW �, (;:i/?rlk•rt INA 5 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT IN..FORMATION <br /> OWNER NAME:..5 CL/IMA ucv°r MEfsJ(S r,4/3 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 54I, PA"V/61;(/ 1 N EV r IC 7`6 IA/A1 (i o33 <br /> CITY Cj (Jt/l+Z/( - STATE 1/04 ZIP 8-i,2.6 <br /> OWNER PHONE: ,U(--- 3(4-4-0 ,L • <br /> OWNER EMAIL: "yyr, 7y1�' I,5i(,(tc� `. 4rwi ' �AYyl <br /> CONTRACTOR NAME: PIA /4,,,.....,0 1--4,242— <br /> CONTRACTOR ADDRESS: STREET <br /> cnY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR 'OTHER(Please Specify) 0 e8 t 5 k <br /> CONTACT NAME: CONTACT PHONE: (71,06) (jg`3 2`3 F'- <br /> C 12 ,(,ti; LAV(,S�� CONTACT EMAIL: 6 aii-9 f11 Q k fii- r( 1 - 6,z`ev, <br /> BUILDING..PERMITAPPLICATION <br /> Existing Use of Building: 'I.1.1 Le- fr--t-t-,( 7 Contract Price of Work:$ O( 6-I- , , <br /> .44. /f &� j jam,�� Heat Source: ['Gas lectric DOther .- fi j(' 5 <br /> Proposed Use of Building: �t l � "' <br /> Building Type: ❑SFR-Detached ❑SFR-Attached Duplex ❑Multi-Family-#of Units: DCommercial ['Industrial <br /> Type of Project: ❑New M�Addition ' temodel DRepair DTI. ❑Sign ['Sprinkler ['Demolition ['Change of Use <br /> DESCRIPTION OF WORK: /_, ,'1 C :� <br /> 4 S BIZ_ ( o <br /> L(63 Sc, r A <br /> /' ratf I u <br /> rid( /t- irk,i C, l �"i.z. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): / <br /> MECHANICAL PERMIT.APPLICATION <br /> _ .PLUMBING P..ERMIT APPLICA_TI <br /> ON': :. <br /> Type of Project: New _ Addn Alteration _Repair Type of Project: _New i---Addn 1/Iteration Repair <br /> #of List of Fixtures #of List of Fixtures <br /> #of <br /> Fixtures List of Fixtures #of List of Fixtures Fixtures <br /> Fixtures 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 I Shower Floor Drain <br /> Gas Fireplace Wood Stove 1 Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> I 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 SYSTEMr. <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.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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only <br /> PERMIT# <br /> q��j8/I C ( / D.. ' + 13 <br /> mei/5 (Revised 10/12/2015) <br /> Owner/Aut . ized .gent Signature Date \ <br />