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PiERMIT APPUCAT OY <br /> BU(LDI MECHANICAL i PLUMB NG I S GN) ,;IIRliNKILER I DEMOLIT ON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 j FAX 425-257-8857 (E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> (Blain or IBlack Ink Only Please) PROJECT SITE INFO[ MATIOIN <br /> PROJECT SITE ADDRESS: 6, /g aND D2 V 6 PROPERTY TAX#: C/0 <br /> 7/(4000 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: eE/ 4 ,4;; nj) TENANT NAME(If Commercial): <br /> (p.l� <br /> OWNER MAILING ADDRESS: STREET D AJD az. J CE <br /> cm' FvElzE!'r STATE ix)A- ZIP q q-7.c <br /> OWNER PHONE: 3/0-440,2-8-0 2. OWNER EMAIL: <br /> CONTRACTOR NAME: DAY d/Orr PLu/ lej,4J6.' cf- HEAT?rt)r7- <br /> CONTRACTOR ADDRESS: STREET //o&11/ /3 /41,.. 60 Q� <br /> crrY tvAhlAve y) STATE WA_ ZIP [ K3-7 <br /> CONTRACTOR PHONE: /4L5—YIc-6g6zi CONTRACTOR EMAIL: SreAriliA) ,0 '�fr &/TEAle�er <br /> CONTRACTOR LICENSE#(REQUIRED):DAAtitt/ -p 1 qa:2u� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):vl g 71_f/ <br /> PRIMARY CONTACT: 0 OWNER IXCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> 42s-7751- oc 0167(7 <br /> g -AO-rJ / A- LC tpe CONTACT EMAIL: gfe.+1,4„,k) DA , vr/Ail ree IL' <br /> (WILDING PIERMIT APPLICATION <br /> existing Use of Building: Contract Price of Work:$ 4,/.5)67, <br /> 'roposed Use of Building: Heat Source: I'd Gas DElectric DOther <br /> Building Type: DSFR-Detached RISFR-Attached DDuplex ❑Multi-Family-#of Units: DCommercial El Industrial <br /> Type of Project: El New DAddition DRemodel DRepair DT.I. DSign DSprinkler DDemolition DChange of Use <br /> DESCRIPTION OF WORK: Repulc Ex)5774)6_ 6,45 �L',e&ACC ,giv0 6.45 Hl?- t/J41-.,'_T,4-)UK <br /> 41n? A-A) 64.5 f er%) pivD 4 ,u-ea) 6,4> f for u4Tn 74- /x, _LA) 5,444--e <br /> L6CA-'r7o,Ji No Neto &745 Yivt7 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APiPLICATIOIN PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn D<Alteration _Repair Type of Project: _New Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures ' #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler I 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 /> SIPRINKLE�-, /SUPPRESSION SYSTIEiM <br /> Chemical or Water I No.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 /> _Trent 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 /> wilding Official before being authorized under any circumstance.I am the owner,or!am authorized by the owner of this properly to perform the work for which application is made, <br /> nd I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERM( # <br /> 11101 11217 j�n �� – �t � <br /> ` � Y► I 6 `7 <br /> Owner/Aut rized Agent Signatur• D to (Revised 9/23/2016) <br />