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Jul 18 2017 12;47PM Washington Wa' '�eaters 8663757454 pagE :": <br /> pERM17 APPLICATI�N <br /> BUII.DING 1 M�CHANICAL J P�.UMBING !SIGN (SPRINKLER! DEMOLITION <br /> CII�Y OF EV�RETT PERMIT SERVICCS <br /> 3200 GEDAR STREE7,EVERE77,WA 98201 <br /> (P}425-257-8810 � FAX 425-257-8857 �(E)everetteps�e�ereliwa.gov� www.everetiwa.gov/permits <br /> (Blue or Black Ink Onty Please} PR�.3ECT Si'fE INFaIi.MAT10N �t <br /> PROJECT SITE ADDRESS: ��� d �l`�. t � PROPERTY TAX#:� OZ- 6600 �w <br /> LEGAL for new construct�on: 5hort PlaUsubdiviaion <br /> Lul fJa (attach cory nf tnnp IP.GRi dESGflptlOfl) <br /> CANTACT IN�IFOitMAT10N ,_ <br /> ONYNER NAME: I! TENANT NAME(If Commercial}: <br /> pWWF_R MAII_INGADDRESS; sTa�Er �gt V I N � <br /> STATE z1P <br /> Cf1Y <br /> OWNEf2 PHONE: zDlfJ'z,�i `Z.'3 Z- <br /> OWNER EMAI l.: �"" <br /> CONTRACTORNAME: ������V'�� ��� n�T�� <br /> . . _ _ � vx 920 <br /> CQNTRACTORADDRESS: srReer I _ �� <br /> p� .�f��!1 STA7E Z�P -" <br /> CRV 4� �V �✓l 1 <br /> CONTRACTOR PIiON�: 7 Z J'"�DJ"y CONTRACTOR EMAIL• � C m���'� � <br /> CQNTRACTOR LiCENSE#�REQU4RED}: �vN'"�� D f!d CITY OF EV�RETT BlJ51NESS LfCEN5E#(RE�WR f� � 7 <br /> PRIMARY CONTACT: ❑OWNER QNTRACTOR� 0 OTHER(Please Specify) <br /> CON ACT NAME' CONTACT PHONE: 2`�J-g 3-y8 7/ <br /> ��� ���-�`� CONTAC7 EMAIL: �,(/f}�i(Il�}7L �"W �-�LGw! <br /> �. <br /> BUILDING PERMiT APPUCATI�N ' � <br /> �xisting Use of Building: Contraet Price of Wor .$ V <br /> Propased Use of B�:Ilding, <br /> Heat Source: ❑Ga, trie �`]Other <br /> BuiEdin T e: ❑SFR-�etached ❑SFR-Altached D lex ❑Mulli-Fami -#of Units:' <br /> -��`C1CommerciaV C�fndu ' <br /> Type of Project: �New ❑Addition ❑Remodel epair ❑T.1. ❑Sign C1S rtnkler ODemolitlan ❑Chan e of e <br /> DESCRIPTION OF WORK: <br /> C�'�(r�-� <br /> _ o�• ���--- � C��c.�-� <br /> ASSOCIA7ED BUILDING P�RM1T# if a licable; <br /> M�CHANICAL PERMIT APPLICATION PLl7MBING PERMIT APPLICATfON <br /> Type of ProJect: New _ Addn ._Alteration �Repair Type of Project; �New ,�Addn _�iteratfon �Rapair <br /> #of � #of #of List of Fixtures �°� L�st of Fixtures <br /> Fixtures List of Fixtures �xtures List of Flxtures FJxtures Flxtures <br /> 7oilei BackQow Preventer Inside Bld ) <br /> A/C-AirHandlin Units HeatPump Urinal <br /> Forced Air 5 sf�ns Unit Heater 6alhtub <br /> Gas Piping Boiler Lavato (Wash Basin) Drinking Fountein <br /> Water Heater <br /> Refri eration 5hower Floor Drain <br /> Gas Fireplace Wood Stove Kltchan Sinfc&Disposal Grease Tra <br /> Gas Ran e Ductin Csishwasher Ronf Drains <br /> 9 Clothes Washer Medical Gas <br /> Clothes Dryer Hookups Other: Other: <br /> Range Hood Water Heater <br /> Exhaust Fan Sink(5ervicelBarlMop/etc. Other: <br /> SPRINKLER!SUPPRESS{ON SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMEN'f:!have reviewed t1�is applica0on and confirm tbe lnformafion contaB;ed herefn is frue and conect.Work dor.e pursuant fo�his permrf must compy wifh <br /> cunenf�eder'al,state,and local lew.The grantir,p ol a permff only aufhorizes approved wodc and no deviations therefrom.Oeviations must first be aulhorlaetl!n wrlting from the <br /> Burldin�Ofl'�cla!6efore being aulhoRzed under any circumslante.!am th neY,or 1 ern authorized by the ownei of thrs property to peAorm the work!or wMch appGcafivn is made, <br /> „ ly wrth the State�Con;racfors Law 18.27 FtC and 296.200 Crly o!Evereft O(ficial Use Ortly <br /> 1 <br /> C' w" �i(�i� P�� `�O � — O� S <br /> D erlAutliorized Aflent Siynature <br /> Llale (Revised 5/?0/'JOi6J <br />