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PERMIT APPLICATI•I`i <br /> Lek- t Pt /66 -0ss <br /> EUILDR— MECHANICAL/ PLUMBING/SIG --PRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> mit Wit 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: 2.5 (ley{� .51 5, PROPERTY TAX#: nOk 4 1,(.'et-\ _3 _4' <br /> LEGAL for new construction: Short Plat/subdivision Lot No. V' (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> fOWNER NAME: R 'S kVA TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1 o i 13 M e✓: c n l v t S <br /> CITY L v eA2-4 STATE W T ZIP F8.1 08 <br /> \\-OWNER PHONE: Z5)7 Sp--`Ir? 5. V..:.1" !<�e0 <br /> (CONTRACTOR NAME: Chin <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ (t 31 <br /> Proposed Use of Building: sr4 Heat Source: Deas ❑Electric ❑Other <br /> Building Type: KSFR-Detached ❑SFR Attached ['Duplex ['Multi-Family #of Units: ['Commercial ❑Industrial <br /> Type.of Project 1 New [(Addition ❑Remodel El Repair DT.I. 0 Sign ['Sprinkler 0 Demolition @Change of Use <br /> 4 DESCRIPTION OF WORK: by;1cJ+it3 q AR.u 1>,`A,,,${., <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 #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> 1 A/C—Air Handling Units ,/ Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater ''V Bathtub Urinal <br /> 'V Gas Piping Lavatory(Wash Basin) Drinking Fountain <br /> . Water Heater ' friger- 1.. Shower Floor Drain <br /> Gas Fireplace Woo• Stove Kitchen Sink&Disposal Grease Trap <br /> \ Gas Range ✓ Ducting i Dishwasher Roof Drains <br /> \ Clothes Dryer Hookups Other: \ Clothes Washer Medical Gas <br /> r Range Hood Water Heater Other: <br /> t1 Exhaust Fan < Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT.•l 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. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> r r <br /> --7/1(0l� ca e, x(0 5- 067 <br /> Owne • . ori :. geht Signature Date (Revised 5/20/2016) <br />