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PERMIT APPLICATIftfl <br /> BUILDIIi— MECHANICAL / PLUMBING / SICSPRINKLER/ DEMOLITION <br /> /IIP/40. ----4 <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 l www.everettwa.gov/permits <br /> r„ <br /> PROJECT SITEINFORMATION_M6a.(4i{. ,, . . , r <br /> PRO/, '5 /4' p R£ESS: RI/I- f 5•Vf��TT i W A 18201 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No._^ (attach copy of long legal description) <br /> r4 ,, _ CONTACT INFORMATION <br /> OWNER NAME: �v£t2•'.TT Ho Is/N1, A vruOt2 0. 1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3/61 Ca t-f3 y R,/£, <br /> CITY V<' .1"rr STATE W 04 ZIP 51/ 20 1 <br /> OWNER PHONE: LIDS' 0755-9 ZLZ OWNER EMAIL: . <br /> CONTRACTOR NAME: /n7, &i(i fe m E4 MANme 14-c- / ///l . <br /> CONTRACTOR ADDRESS: STREET 1/2.cit P46/i~/G h4/6,1114/191 / Si//7 i e- <br /> /� <br /> CITY 4�. -1iVL.,yIgowl STATE WM ZIP CJt52,2c, <br /> CONTRACTOR PHONE: 360 -3$y-V$O p CONTRACTOR EMAIL: YGONSTr4AI1- '798rr1G./NG•Le,owl. <br /> CONTRACTOR LICENSE#(REQUIRED):, T s r4K$m c1 z 2 KA/ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0535$•6/ <br /> PRIMARY CONTACT: ❑OWNER E CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 3(0-3$4-Std p <br /> Y14"/G.v1 L0ni -j',44...)-1- CONTACT EMAIL: Ye..ont 5T>IN 7(-4 erldmC//VC•Go Pun- <br /> „ct <br /> ,. �`: wu,,, -..fi> , . r : BUU DIINGrP1 RMIT APPLICATION- , <br /> Existing Use of Building: Contract Price of Work: $ . <br /> Pro•osed Use of Buildin•: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex 0Multi-Family-#of Units: [Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair CIT.!. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> a �A.i"V 'h Hi er y” . <br /> °:* .':. tIT APPL CATION 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 /> Gas Piping Boiler , Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeation ShowerFloor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher 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 /> / Willtrc. 414//.1 Rfet-.tc Litters <br /> .. ,0 . ,7` a R O -SYSTEM <br /> INumber.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# <br /> ,�,iZ-�--- s-3-2�t� P t6os-ool <br /> Owner/A prized Agent Signature Date (Revised 10/12/2015) <br />