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1 PERMIT APPLICATION <br /> "171/4ri----1 <br /> BUILDIN MECHANICAL / PLUMBING /SIGI ---yPRINKLER/ DEMOLITION <br /> Niiid WY <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 vvww.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION I <br /> PROJECT SITE ADDRESS: Z S T S c S uJ PROPERTY TAX#: Z gr�sl) 'Z no S D Coo( <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 5t-109/1eMi y,} (Anu.vi y -Pa.0 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2 3 Z o c_.-+-1 y trorC►-'i i <br /> cITY y t 1Y T T STATE Uv/j- ZIP `l 0 Z a ) <br /> OWNER PHONE: (4 ) 7 QJ • 2S45 OWNER EMAIL: <br /> CONTRACTOR NAME: DL S l 't-Lt r1 in 1.--J <br /> CONTRACTOR ADDRESS: STREET 2(a a \C1 (o" i L vi 2 ee <br /> cm, 14A. N�v0, STATE V.-)b9- ZIP `1$P b <br /> CONTRACTOR PHONE: Z. -- "744 - 603Dv CONTRACTOR EMAIL: ltvt j e cDo&eAL4..\ i o,?s+'lw,AC/— <br /> CONTRACTOR LICENSE#(REQUIRED): '(Z&OLbL at 341C.j( CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): cZ0o1 ) <br /> PRIMARY CONTACT: 0 OWNER (CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4- -1 4 -1.,s.01., <br /> 7 <br /> i /ltN) t) L 4vD+^d11)t_ CONTACT EMAIL: ,i..tu j ,,‘1j f,O I uT,r�ti./1w,n��' <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: IQ t L.t- Contract Price of Work: $_7 C d 12 <br /> Proposed Use of Building: OFC Heat Source: Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: t4Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition A Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Ix,brht.t. 4y C •Qu t PM4;a-•T- 1 (rdop- �¢RINc2€t.rtr <br /> S -e <br /> .i✓MO J.G <br /> Io f4- Rt,0E-t--(r 1.sioce_ G <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 /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> -, Forced Air Systems Unit Heater Bathtub Urinal <br /> I I Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> l Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal -r�� Grease Trap <br /> Gas Range Ducting Dishwasher L 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 /> Chemical or Water I No.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 /> PERMIT# v j \ \\ , ,_6 <br /> 11 zo , Ie, <br /> -- .uthorizaAaen ignature Date (Revised 9/23/2016) <br /> 2i <br />