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- -- PERMIT APPLICATIO <br /> BUILDING—ECHANICAL/ PLUMBING /SIG RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERV! <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 Inr i�ry, ea e) , . `�:. PROJECT SI INFORMATION <br /> PROJECT SITE ADDRESS: '21O mot', Iz `J tet- Wer <br /> PROPERTY TAX#: SQA V1 ti <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (,)yOtI ('.(a(, 0040.. jt/e.,/CjATENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET f L. E , mg**ha.,1AguiS• <br /> CITY 1-14,(4.ly(At. STATE WAn ZIP V'ly <br /> OWNER PHONE. ',Olo• 1 e • 1(.0q2.- OWNER EMAIL: ft4r..410.445 • VOG<VI q A•e 2.00CPJ .000 <br /> CONTRACTOR NAME: J6L --A S. I yvtglef' <br /> CONTRACTOR ADDRESS: STREET 4 16 ',sr (. ()v-i(/1 ,sIn.tfi-e 4DD <br /> CnY Se/t V. STATE 04011/4" ZIP 179 10 <br /> CONTRACTOR PHONE: j4)1P . 4-4.1 . "1 -1(p CONTRACTOR EMAIL: Vi II'ttbV0 P al rtsvq C ,Covvl <br /> CONTRACTOR LICENSE#(REQUIRED): 110 AI-(� SW ibtoi Sell CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) 05-25-3A, <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR lit OTHER(Please Specify)__ eStAii4 <br /> CONTACT NAME: CONTACT PHONE: ZA2,, Q71 <br /> \� hllko CONTACT EMAIL: <br /> .I'FbV'I'i VNoa7v ..4,,xdesle(h .ezvtit <br /> tveMAFP . GA�ION <br /> Existing Use of Building: alit tie eSS Contract Price of Work:$ O(.b . OQ Q <br /> Proposed Use of Building: (tfl Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached CI SFR-Attached ❑Duplex ❑Multi-Family-#of Units: tgCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair gr.!. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 45C,1)(1.eWWy...- 1 y‘ettAsit S 'rYl4 dietAtt011 LI& O S(,ttiat Wit El 4 ccou.-S 44,41 CltS;OA4-* <br /> WAS aik 0 - 112.10k) SGL ADO/1; 1/144Wefriev-vkt Of i rti Mt5 1 n 4.seQC of- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL;PERMS f`APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures List of List of Fixtures #of List of Fixtures #°f 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 1 SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT:/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 /> \AAA), ov0 . lb ,ILD D)626(0-033 <br /> Owner/Autho d Agent Signature Date (Revised 5/20/2016) \� <br />