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PERMIT APLICATION <br /> /11jA <br /> BUILDINGTMECHANICAL I PLU BING I SIGN I S NKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue�or,Black InkaOnl Plea e .PROJECT SITE'`INFORMATION..`.' <br /> PROJECT SITE ADDRESS:S , ' i akretk SW PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> " ' CONTACTINFORMATION:, <br /> OWNER NAME: k iN )(0,40,,N)pn TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 5 1 S+ - pJr Sl1J <br /> cnv 1�\}}'1 P STATE ZIP q ga o 3 <br /> OWNER PHONE: ���' OWNER EMAIL: <br /> CONTRACTOR NAME: C A S\1hYY\ t) I .,S i <br /> CONTRACTOR ADDRESS: STREET.-1JD O S. 1e 'e. "P�IJVI,\ ST`e., 701-1 <br /> cnYC` A-enn() Q' STATE C o ZIP gd II a <br /> CONTRACTOR PHONE:LI a5-t.05°Voff" 0 CONTRACTOR EMAIL:1(y')(-u 'tto eL .COnei <br /> CONTRACTOR LICENSE#(REQUIRED):(C4'.141- i 1g CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):577 Q'7 <br /> PRIMARY CONTACT: 0 OWNER XCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> �.�� L�\\uw��- . 303 Stc3 - 9553 <br /> CONTACT EMAIL: l/1sevela f .�} d e /S a <br /> 1M,BUILDING;I ERMITAPPL'ICATION. ,lR, , <br /> Existing Use of Building: Contract Price of Work:$ c:Q q/0 O 0 <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: CI New ❑Addition Alemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: N 2�( ' -r;mber'"recv\ deck. <br /> . w('r'i ccocAe rat klyli� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL-PERU IT APPLICATION �`. � �� '��"' "PL""UMB'IN"G PERMIT'APP,L''ICATION <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 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';F .-".-. <br /> 'Chemical or Water I No.of Heads <br /> ACKNOWLEDGEMENT::I have reviewed this application and confine 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.lam the owner,or lam 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 /> 5 ►7jPERMlTQ ( <br /> Owner/ zed nt Signature Date / I (Revised 9/2/2016) <br />