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IIIIIII 4reirPERMIT APPLICATION II IIIIII <br /> BUILDIN�II�IECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ♦, 50/IPROPERTY TAX#: 3 goo° <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT,INFORMATION.;:,,. <br /> jamw <br /> OWNER NAME: tTENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /717... 81e1111 SVV <br /> CITY 0/ilereeSTATEW". ZIP qg <br /> OWNER PHONE: pc& 7 l tic21 OWNER EMAIL: po I ''�t . <br /> CONTRACTOR NAME: 4-14071f �l e * r (jl/V <br /> CONTRACTOR ADDRESS: STREET \/ <br /> CITY A0011/`1 STATE ZIP <br /> CONTRACTOR PHONE: 111 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 3$7S <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR OTHER(Please Specify) IVG GJ L 4.1-7 <br /> CONTACT NAME: „ti.f--frk bIYgG(/,` CONTACT PHONE: 2192' 7/ <br /> CONTACT EMAIL: S `th0 c' eo.0r <br /> BUILDING'PERMIT'APPLIGATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: (`e2(/7 ,) Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached Inpuplex ❑Multi-Family-#of Units: . commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition remodel ❑Repair ❑T.I. OSign ❑Sprinkler ❑Demolition ❑Chang f Use <br /> DESCRIPTION OF WORK: ail a - j /11,4C Gj/IL( r 0/rerot -- <br /> hvl k ad in nian�vracfviln.07, , cm v c✓'41l e <br /> � nlvu W sf 9J tI5. <br /> 5 l <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 /> NC—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 I 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 com'ly with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of EverettrOfficial Use Only <br /> `�►. ' )N 'n� O� � PERMIT# � l lf✓D DD <br /> Owner/Au, orized gent Signature Date (Revised 10/12/2015) / <br />