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BUILDIN�TIGIECHANICALE P UMBING CSIG�INKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-2�7-8$10 � FAX 425-257-8857 �(E)everetteps@everetiwa.gov� www.everettwa.gov/permits <br /> (Bl,ue dr Black 1nk E#nt�P�a��.= PRO.�ECT�ITE IN�CiRM/d►"'�"1�N ` <br /> PROJECT SITE ADDRESS: � K Q,�-�1 a�I �VI PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATlON <br /> OWNER NAME: }� L rp TENANT NAME(If Commercial): ��- 4 S�� <br /> OWNER MAILING ADDRESS: s�xEer �(/ <br /> CITY 0> n/� 1,Q. STATE �� ZIP ( C�o <br /> OWNER PHONE: �-I������ pc �► OWNER EMAIL: ��� Y�IG S ,�`� <br /> CONTRACTOR NAME: S�� ,� .v°j <br /> CONTRACTOR ADDRESS: s�e�r (p � �¢,,�I��Ct� �� <br /> CI1Y ��( �C STA7E �u ZIP (J 1 <br /> CONTRACTOR PHONE: � - jy� CONTRACTOR EMAIL: � S '�/� , (gbv� <br /> CONTRACTOR LICENSE#(REQUIREO): � _ . ��� �0 OF EVERETT BUSINESS LICENSE#(REf�UI ED):S <br /> . -- _. , __ __,. __ <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR IgOTHER(Piease Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> ��y� �� GONTACT EMAIL: e�y- t� S�i, : :�,�,e., + �O <br /> BUILDING PERMIT AI�P�.1��'�`1QN <br /> Existin Use of Buildin : Contract Price of Work:$ —' <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Buildin T pe: �SFR-Detached ❑SF -Attached �Dupiex ClMuiti-Famil -#of Units: ommercial ❑Industrial <br /> T of Pro'ect: ❑New ddition �Remodel ❑Re air C7T.1. ❑Si n ❑S rinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: <br /> ;�,Sa-��� �,�� �.-�- o�- �E �� e.���,ti,.e.� �e� �� �,��.e ����s <br /> ASSOCIATED BUILDING PERMIT# if a licable: <br /> MECHANICAL'PERIHI`P`APRLICATtON PLUMBING PERMIT APPLICATION ` <br /> Type of Project: _New Addn Alteration „_Repair Type of Project: _New Addn Alteration _Repair <br /> #of ��s!of Fixtures #of ���af�xtures #of /.�st of Ffictures #of List of F" <br /> Fixtures Fixtures �xtures Flxtures <br /> A/C-Air Handlin Units Heat Pump Toilet Backflo eventer Inside Bldg) <br /> Forced Air S stems Unit H er Bathtub <br /> Gas Pipin Bo' Lavatary(Wash Basin Drinkin Fountain <br /> Water Heater efigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposa Grease Trap <br /> Gas Ran e Ducting Dishwasher Roof Drains <br /> Clothes Dryer H ps Other: Clothes Was Medical Gas <br /> Ran e Hood Water H � Other: <br /> Exhaust F Sink ervice/Bar/Mo /etc. Other: <br /> $PR KLER%$#1PPRES$Xt3N Slf$TEM i' <br /> emical or Water No.of Heads <br /> ACKNOWlEDGEMENT.•f have reviewed this application and con�rm the information contained herein is true and correeck Work done pursuant fo this permit must comply with <br /> cunent federal,state,and/ocal law.The g�anting of a permit only authorizes approved work and no deviaGons therefrom.Deviations must first be authorized in writing from the <br /> Building O�cial before being authorized under any circumstance.l am the owner,or I am authorized by the owner of this property to perfomr the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.ZODA WAC, <br /> City of Everett O�cial Use Only <br /> l`fa PE�#�-C --�b <br /> Owner/Aut ed Age Signat Date �\ � (Rev ed 9/23/2016) <br /> ` <br />