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PERMIT APPLICATIO <br /> � BUILDINCH-ILIECHANICAL/ PLUMBING /SIG RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <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 /> r' PROJECTrSITE_INFORMATION r.,.x _ �9, ....�;. , . , _r.,. <br /> PROJECTSITE ADDRESS:, <br /> UC & E <br /> .A✓t , V.r{N'/ wti �/FZ[�1 PROPERTY TAX#: z'lU y3 L/ - 009 -0011 -OO <br /> LEGAL for new construction: Short Plat/subdivision Kee. CdP tit rot Lot No. I (attach copy of long legal description) <br /> >' CONTACT INFORM4TIOM } <br /> OWNER NAME: (4)6, ,r' 44,1:' 4 r''StLS 1.,LL TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1 S 2 2- j Gc IA fir by,u't. <br /> CITY! `...‘th Edey A STATE (AJ a ZIP I t'( i7 <br /> OWNER PHONE: 1-125 7L(3 17 I8' Rota r;St,S �6). )04f I OW <br /> .,.OWNER EMAIL: . .�. <br /> CONTRACTOR NAME: vg(jai?' Ir."-1,4r r;SO L,L C <br /> CONTRACTOR ADDRESS: STREET I5-era a C 4,54 i „ <br /> CITY tt,4 tttfn ' ' ,) DOI STATE ZIP ' ✓7 <br /> CONTRACTOR PHONE: 1, 7s--71,i „ t 7!f CONTRACTOR EMAIL: 1p'° YpfE,€� 6) ,..„91, 610 <br /> CONTRACTOR LICENSE#(REQUIRED): R E L O?Z CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: DOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> Vt4(4:4- CONTACT EMAIL: 444;r e4%�" y, L� 't .# d <br /> 3 .. ., A' „r..a,v.`iita -. :;BU L©1NG_PERMIT'APRLICATION may,. n. , _w -a,. ,aligna <br /> Existing Use of Building: Contract Price of Work:$ L/OS, 0 U 0 <br /> Proposed Use of Building: `r FR MEW Heat Source: ; Gas ❑Electric ❑Other <br /> Building Type: IZSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: jiiKew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMITxAPPLICATIOM; <br /> Type of Project: t'.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 /> 04 A/C-Air Handling Units t Heat Pump Lf Toilet 0 Backflow Preventer(Inside Bldg) <br /> 1 Forced Air Systems ) Unit Heater 2 Bathtub 0 Urinal <br /> Gas Piping 0 Boiler b Lavatory(Wash Basin) U Drinking Fountain <br /> I Water Heater d Refrigeration 2_ Shower _ (� Floor Drain <br /> I Gas Fireplace e.3 Wood Stove I Kitchen Sink&Disposal 0 Grease Trap <br /> ( Gas Range Ducting I Dishwasher (' Roof Drains <br /> Clothes Dryer Hookups Other: / Clothes Washer o Medical Gas <br /> Range Hood I Water Heater 0 Other: <br /> h Exhaust Fan , Sink(Service/Bar/Mop/etc.) U 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 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 /> MIAPERMIT <br /> it�Z— <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) `/ <br />