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A <br /> + —it PERMIT APPLICATIO <br /> G1 MECHANICAL/PLUMBING I SIGNT <br /> RINKLER/ DEMOLITION <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 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: I1 120 t•ievcJy eev- '11Q/ t-C a r� D PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision J 1 Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:Uoi IayjA91vj LILA* /ttS'L )n)C TENANT- NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1.3530 142n AUG. w <br /> CITY M of.; I-I-Q.o STATE \j. II ZIP el 275 <br /> OWNER PHONE: f OWNER EMAIL: <br /> CONTRACTOR NAME: 14 iv - pvw p I U vvI b i iii and SPi../-e-V <br /> CONTRACTOR ADDRESS: STREET 251) 0 itey CIrcl,z IN. <br /> CITY 6011,,a STATE Wt"c- ZIP c e0IZ <br /> CONTRACTOR PHONE: tab-372- -2 05 CONTRACTOR EMAIL: arnprY1I,'Un'Ibin9 Q Wte-•C-0)17 <br /> CONTRACTOR LICENSE#(REQUIRED)NIVI p,2s'90 LIKE CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Lie <br /> PRIMARY CONTACT: prOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> ii 11. <br /> CONTACT NAME: CONTACT PHONE: -76 c- 372- 2 g DS— <br /> De111\G' L Phr(to1d CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ /1 b 0 O <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel DRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 0(1514 10604 1 On <br /> V' tr <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ` `-( - 0 ' Q\ <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> of #of List of Fixtures List of Fixtures #°f 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 /> Gas Piping B ' r2_ Lavatory(Wash Basin) Drinking Fountain <br /> r` ter9eate Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal P Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood 'I Water Heater 3 Other: Inas S;,,Ks <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 OfficiallUUseOnly <br /> k <br /> } PERMIT# p Rao `)`JV <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />