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T/ „�_.7 PERMIT APPLICATION <br /> ./ BUILDIN2 i MECHANICAL I PLUMBING /siGri OPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERV <br /> /� b 3200 CEDAR STREET,EVERETT,WA 98201 <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: ' (I I i (_,.....f, ,ry PROPERTY� ETAX#: <br /> LEGAL for new construction: Short Plat/subdivision l• U�' /�� ot No. (attach copy of long legal description) <br /> CONTACT'.INFORMATION <br /> OWNER NAME: IrOkriY 1 TENANT NAME(if Commercial): <br /> OWNER MAILING ADR ESS: STREET <br /> CITY (/ f ei1 STATE 6,41X7 ZIP ,/y����J <br /> OWNER PHONE: c72o 9Lio / 67 l(7/ OWNER EMAIL: Z �i �y r03 ISI-":G[�Y C <br /> CONTRACTOR NAME: Wes C em/Sfx, / G i-/Dxy x.11 oeyn 0i4cr.ey 9...MOur_a .44,) .... <br /> CONTRACTOR ADDRESS: STREET )So c 44i0/Ne- /)/- 11/e" 1,0-e4C-OV,-k-'" <br /> CITY /0 7 fj-fe f t.,///e / STATE �42 ZIP geoz 7i <br /> CONTRACTOR PHONE: 3 G,0 (p 5 8 o?yo CONTRACTOR EMAIL: <br /> 7I'-PCONTRACTOR LICENSE#(REQUIRED): 4)ES OC X-9/co 6 / CiTY OF EVERETT BUSINESS LICENSE#(REQUIRED):(965-74 — <br /> PRIMARY <br /> RIMARY CONTACT: 0 OWNER ❑ CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONT T EMAIL. Inv- trtivi <br /> BUILDING APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ t1R c�� <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric 0 Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: 0 Commercial CI industrial <br /> Type of Project: ❑New DAddition El Remodel El Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition El Change of Use <br /> DESCRIPTION OF WORK: <br /> / `►teliS %ll/ (9/9—/A5 <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 /> 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 /> 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: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 em the owner,ori am authorized by the owner of this property to perform the work for which application is made, <br /> and/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> ...0011.' City of Everett,Official Use Only <br /> PERMIT# <br /> Own / thori-ed Agen Ig ure Date / (Revised 10/12/2015) <br /> L. <br />