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PERMIT APPLICATI <br /> BUILDS MECHANICAL/PLUMBING/SIGF+i'RINKLER/DEMOLITION <br /> 7 CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 I(E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE.INFORMATION <br /> PROJECT SITE ADDRESS: 10 ' ! F6 W b'dlow°tom`" S PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 51/1-04tor (A5(+_ r t,{„C— TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 103,10 LA cSDLLAr v( bIL X51. 41 <br /> CITY 56114 W14 STATE Lik• ZIP GSAZI, <br /> OWNER PHONE: 0.2.0 *V"'' -,— OWNER EMAIL:wartN 1 dt <br /> CONTRACTOR NAME: P ` eaAlktiU7 jN (! <br /> CONTRACTOR ADDRESS: STREET 4120 'sr P1. 4,1,4 <br /> CITY vANNwin%0 STATE W ZIP 4 gy <br /> CONTRACTOR PHONE: r2)%1- fi CONTRACTOR EMAIL: Q /; ' owl / <br /> #(\ <br /> CONTRACTOR LICENSE REQUIRED): 0.1004X,1410, CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):flcSjytko <br /> PRIMARY CONTACT: D OWNER rlitlCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT (142c-5gqNAME: CONTACT PHONE: %7. 071 <br /> e%�ll PHS CONTACT EMAIL: �hOrW1SC ttS o,wiA liON1 <br /> BUILDING PERMIT APPLICATION t� <br /> Existing Use of Building: Contract Price of Work:$ 101/4411,112' <br /> Proposed <br /> DtM46112- <br /> Proposed Use of Building: Heat Source: ❑Gas ISElectric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex /8JMulti-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel 1 Repair DT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Tiro- finiativa ;,( , t rcpt t# <br /> dtealwwt own <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 List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C <br /> —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 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 /> SPRINKLER/SUPPRESSION SYSTEM <br /> •Chemical or Water 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 Official Use pnly • <br /> PERMIT# <br /> ���`,^��� "] <br /> Owner/AC uthoriztd Agent Signature 51Date2111 O — O 3 <br /> (Revised 9/23/ �) <br />