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1 ii <br /> RMIT <br /> /414,� BUILDINA I MECHANICALS/ PLUMBING I SIGNNI!PRINKLER/ DEMOLITION <br /> 11.*#/411 <br /> CITY OF EVERETT PERMIT SERVICES <br /> „oil 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: / /I 9._0 J e?r r ,,, h W a 1 0 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision 1,.5 Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION ------ <br /> OWNER NAME: TENANT NAME(If Commercial): \ en, , � <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: f3 t‘\ .S P 1)vv, <br /> 6 V 4,4"1l'°< <br /> CONTRACTOR ADDRESS: STREE PG i x 713 / U <br /> �„`I I\l UJ O 0 t CITY STATEAA ZIP 9 V I el <br /> CONTRACTOR PHON-. I- . j-'9 r! I i(o CONTRACTOR EMAIL: <br /> CONTRACTOR LICE SE#(REQUIRED): <br /> CITY OF EVERETT BUSINESS LICENSE#(- QUIRED): <br /> PRIMARY CONTACT. 0 OWNER L31ONTRACTo- 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> O'A.:. <br /> Existing Use of Building: Contract Price of Work:$ I S cs 0 <br /> t <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family #of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ulv CrtS2— <br /> in <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 #of List of Fixtures List of Fixtures #of s 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 Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal k Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood / ' Water Heater Other:=�(A-..A-e2J� <br /> Exhaust Fan a 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 /> // r> City of Everett Official Use Only <br /> �'IL., (-"tivz )) tL(i// ,�� id� Z�i) PER ^ 1 0 <br /> Owner/Authorized Agent Signature Date .Revised /23/2016) <br />