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PERMIT APPLICATIOII <br /> #11111.PA -----A <br /> BUILDIN_ECHANICAL I PLUMBING /SIGN': =RINKLER/ DEMOLITION <br /> - CITY OF EVERETT PERMIT SERVICES <br /> ,44a4 <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 /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ZG3 .7$ PL S r IPROPERTY TAX#� <br /> LEGAL for new construction: Short Plat/subdivision 4(P i•tc,UP.r /:n fs Lot No./.O (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 114/4,fie Jleiy its LL e--_ TENANT NAME(If Commercial): j p <br /> OWNER MAILING ADDRESS: STREET 1,,)© 'rj L 1 e <br /> L, ( "'cr/ ffl q.. I A� 'S #L_. 6 e 00 (� ^� <br /> CITY Itp=�Clt STATE yw 'St z C Ira°y <br /> OWNER PHONE: 1-05- q53- OWNER EMAIL: (AJ it,)W S e,ci t;--Inoy,7 e S. c 1 <br /> CONTRACTOR NAME: 5 Q PG;c 14tapsi eS <br /> CONTRACTOR ADDRESS: STREET /r. S Cal E()e#-d' Arne,I( W ci Ryp7( <br /> CRY E. L� '.r STATE L4)" . ZIP I <br /> CONTRACTOR PHONE: 44,)-...5_ 953> v9-v©O CONTRACTOR EMAIL: 14/14,1,4e. S.eci. pc..1)0 Ion e5 m (c# <br /> CONTRACTOR LICENSE#(REQUIRED):5 A?j1 pi/156 t..'7 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):O5 33 9 <br /> PRIMARY CONTACT: O OWNER 0 CONTRACTOR '1g.QTHER(Please Specify) Pro <br /> ...e c f flu,A cr,e g.--- <br /> CONTACT <br /> /CONTACT NAME: CONTACT PHONE: LOS> 3 ,D 5 ti 41 30 <br /> P4A# Ro Se11loe ci... CONTACT EMAIL: main y- tochi cc; 0,4,,,,,,s a conn <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building: HEAT SOURCE: <br /> Proposed Use of Building: ❑Gas *lactic DOther <br /> Building Type: OSFR-Detached I:SFR-Attached ❑Duplex ❑Multi-Family-#of Units: OCommercial 0 Industrial <br /> Type of Project: )flew OAddition ORemodel ❑Repair OT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Ra 35 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATIO <br /> Type of Project: New Addn _Alteration _Repair Type'of Project: KNew _Addn Alteration _Repair <br /> #°f List of Fixtures #of List of Fixtures #°f List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump 7 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater / Bathtub Urinal <br /> Gas Piping Boiler 5 Lavatory(Wash Basin) Drinking Fountain <br /> II Water Heater Refrigeration , Shower Floor Drain <br /> Gas Fireplace Wood Stove I Kitchen Sink&Disposal Grease Trap • <br /> Gas Range Ducting / Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: / Clothes Washer Medical Gas <br /> i Range Hood r Water Heater Other. <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER I SUPPRESSION SYSTEM <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 th <br /> Building Official before being authorized under any circumstance.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is de, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. t!( <br /> of Everett Official Use Only la- <br /> City <br /> 7/7„,7,16 .,..4.--/-4.....i.44 / —(5'-- <br /> // PERMIT it <br /> Owner/AuthorizedAaent Sia nature Date (Revised 10/12/2015) <br />