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PERMIT APPLICATi S l: <br /> _ I� <br /> BUiLDIMECHANICAL/ PLUMBING/SIG 11• PRINKLER./ DEMOLITION <br /> N�, CITY OF EVERETT PERMIT SERV <br /> NIMIWI <br /> 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 /> (Bleat ..0 .lack hi)k._*obi 0.11,06) • . PROJECT:00'1'.FORMATION .: - <br /> PROJECTSITE ADDRESS: 2Z.0` -- t 0"Ct f S, S.0. PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Gra 6,(ct',cL TENANT NAME(If Commercial): OA be <br /> OWNER MAILING ADDRESS: STREET <br /> CiTY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL:g(,f,•e4 9ok14LY 41 , inin <br /> CONTRACTOR NAME: �� 612 e .J' „� S I4T H -"'C' �C 1' <br /> CONTRACTOR ADDRESS: STREET 2I 2c .F -G(,,^ <br /> CITY ( �/�C/ STATE V • ZIP [.L�� <br /> CONTRACTOR PHONE(yzc) ZZ—3/ft/ ( CONTRACTOR EMAIL: m Qg 55/-"l ti .. caw <br /> CONTRACTOR LICENSE#(REQUIRED): gRe.< ( ) 4.J. <br /> CITY OF EVERETT BUSINESS LICENSE#REQUIRED <br /> PRIMARY CONTACT: ❑OWNER 549CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:(VZs,1,sz—5/14-/ <br /> e,-,--3 .J�`��C:. CONTACT EMAIL: .k,eAirdr,5 5#244) C/ayt- <br /> :. .. -UILbI • <br /> ° � � - NG.EERMIT;APPLICATION �' <br /> Existing Use of Building: Contract Price of Work:$-_&31;e= <br /> Proposed Use of Building: Heat Source: XGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR Attached ❑Duplex ❑Multi-Family-#of Units: El Commercial ❑Industrial, <br /> Type of Project: El New ❑Addition El Remodel ❑Repair ❑T.I. ❑Sign El Sprinkler El Demolition El Change of Use <br /> DESCRIPTION OF WORK:J DCA-Cf- Lc-9 V PF OF ‘ :-.%(/c-fl es sI�--es1/IA. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> :.‘. .... <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 #°f List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> I 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 /> $0410400-./$.0.00 ES ION SYSTEM... . ;..• <br /> Number of Heads <br /> ACKNOWLEDGEMENT 1 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!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 /> 5)4 i 9 r-1 if...---16 City of Everett Official Use Only <br /> PERMIT# i (0 <br /> 011 31 <br /> Owner/Aut orized Agent Signature Date (Revised 5/20/2016) (c) <br />