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1(016-17- PERMIT APPLICATIOI'I <br /> BUILDIf 'IECHANICAL/ PLUMBING /SIGN ' .INKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue;or BlackInk Only Please) PROJECT SITE INFORMATION ' <br /> PROJECT SITE ADDRESS: 2,3 06 Le mbielej) k PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 1i A '\e TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2,56?) 1-61116Al2n MS <br /> J& tt CITY STATE Q ZIP 9 2,.,.0 l <br /> OWNER PHONE a06-S53--b e)4--5 OWNER EMAIL: ib. 11(vtaslyi(11 oilie e)3 ma',l.coal <br /> CONTRACTOR NAME: .5 e) Zef 9 1 11M/t11(' <br /> CONTRACTOR ADDRESS: STREET `C5((n ifk .SililitLJ . <br /> CIN SnOil6MicV1 STATE WA- ZIP 91 25(..7 <br /> CONTRACTOR PHONE: 360-512 .--9.1b4 CONTRACTOR EMAIL: 64;ce 5(' -i 0 rp(um k t rc i <br /> CONTRACTOR LICENSE#(REQUIRED): 5g:1-Lop 1 Zee.__ CITY OF EVERETT BUSINESS LICENSE#(RE e d RED): , AP. <br /> PRIMARY CONTACT: 0 OWNER N-CONTRA - P OTHER = -ase Specify) <br /> CONTACT NAME: <br /> 0215 ' ONTAC PHONE: <br /> ACT EMAIL: <br /> BUILDING:PERMIT,APPLICATION `"" <br /> Existing Use of Building: S� %�-j�1 Contract Price • I ork:$ �0C <br /> Proposed Use of Building: Qty ql id)c,( Heat Source: • • lectric ❑Other <br /> Building Type: . SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial 0 Industrial <br /> Type of Project: ❑New DAddition ❑Remodel bilRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> A a i 446' ckY.., +1\1... 5tA5?ecf, co ed rluimbinci wa rerrlC red t- ret'l(acctl kl1 A-i g, <br /> scone, kec +-yen 0-5 -11‘12. O( 5;nal f <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICALPERMIT 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 #°{ List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump I Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater 1 Bathtub Urinal <br /> Gas Piping Boiler 1 Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove t Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting i 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/SU,PPRE,SION SY$TEM `�,,,r . <br /> !Number 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.lam 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 /> 13 /..2 <br /> R IT <br /> - .�-�� kc 2 — of L4 <br /> Owner/Authorized Agent Sig ature Date (Revised 5/20/2016) <br />