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PERMIT APPLICATIO <br /> .° itai, i BUILDI ECHANICAL/PLUMBING /SIGN�1RINKLER/ DEMOLITION <br /> -.11:— CITY OF EVERETT PERMIT SERVICES <br /> � f 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 /> (Blue or Black Ink Only Please) ;ZA,/ PROJECT SITE/INFORMATION ' (, - ��y��PROJECT SITE ADDRESS:(3& 3 W ale/4A 1 9 Z.� PROPERTY TAX#:2,d O7 U3 �b1� <br /> J <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long le description) \ <br /> CONTACT INFORMATION 1 <br /> OWNER NAME: Rgiikihd 117,44,e... 1 .41.4 TENANT NAME(If Commercial): #444/7W42 l k <br /> OWNER MAILING ADDRESS: STREET <br /> ��„p li t2 R;(9- ?19;p `-kt , 1;9-A 3515 J <br /> /CITY 7 .` :zZ ✓ STTATTE�,�iliA ZIP9fki <br /> OWNER PHONE: rz.5•y79-, `if.' VV OWNER EMAIL:I � a 91. 0 tg <br /> U..GDJY). ....... .. <br /> CONTRACTOR NAME:/Vb f J 1 i. � ✓ _5 <br /> dr <br /> ;r0 ADDRESS: STREET 7 .S�J`17 A ��' <br /> CITYitZde,„") 11STATE ZIP �g�✓7 <br /> CONTRACTOR PHONE:q26-2.59t7.5750 CONTRACTOR EMAIL: / j/p? „J44.41:5111 <br /> CONTRACTOR LICENSE#(REQUIRED)Abr-�W 11z754-e CITY OF EVERETT BUSINESS LICENSE#(REQUIRE a): O 15A” <br /> PRIMARY CONTACT: 0 OWNER . CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Lys G;.'. 9,/�' 3577 <br /> Ak) ) in - yte-- CONTACT EMAIL: �eivir). , �,l��� <br /> BUILDING:'PERMIT APPLICATIO 1 .. ; <br /> Existing Use of Building: Akf rL Contract Price of ork:$032,•57? <br /> Proposed Use of Building: 11 Heat Source: c: ■ - ■• <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: SaCommercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair 547.I. DSign ❑Sprinkler ODemolition OChange of Use <br /> DESCRIPTION OF WORK: , ) 4/471. <br /> 7L 1�^ii-jj i ,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 /> 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/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 b ng 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 e Contractors Law 18.27 RCW and 296.200A WAC. <br /> 1 City of Everett Official Use Only <br /> 24-1 ) 1 P 7T\ � - Vl.Z <br /> Owner/Authorized Agent Signature Date (Revised 5/20/2016) <br />