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PERMIT APPLICATIO <br /> '1111;;;A <br /> BUILDIN MECHANICAL/ PLUMBING /SIGN INKLER/ DEMOLITION <br /> imOd 1� CITY OF EVERETT PERMIT SERVIC <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 /> PROJECT.SITE INFORMATION,. . <br /> PROJECISITE A l lR _: n, PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ,CONTACT:I N FORMATIO N <br /> OWNER NAME: Sea' 8- b"CG`r CL,.. ;ottiKTENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srasEr 214( A(Ue So-✓\ g i o CA <br /> CITY V e-f e T STATE WA - ZIP ?g2O <br /> OWNER PHONE: ER EMAIL: <br /> • <br /> CONTRACTOR NAME: ©W lk,(_/{ S 0 ..( C <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY.OFEVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT:) 'bWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (-„f z.ct- 9 ( - o ?j?5+ <br /> ��- t,r �ifJ`k CONTACT EMAIL: d�„�P/ to(?f 5�t CO d `/ <br /> - <br /> BUILDING:PEitou ARPLICATION a . _ . <br /> Existing Use of Building: R(, Oiivl C Contract Price of Work:$ 5 D(®VV 't lie--e - <br /> Proposed <br /> c e -Proposed Use of Building: Q- k._ Heat Source: °Gas ,atlectric DOther <br /> Building Type: DSFR-Detached EISFR- ttached °Duplex DMulti-Family-#of Units: °Commercial Dlndustrial <br /> Type of Project: DNew °Addition emodel °Repair DT.I. °Sign ©Sprinkler °Demolition DChange of Use <br /> DESCRIPTION OF WORK: <br /> Nl.oa A- to Poo ML fe.vvuod d- G 0( Gte- -- 5 C-C5� Z <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> :'MECHANICAL PERMIT APPLICATION • .. • . : :. , 000.1.00.0.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 /> NC-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater I Bathtub - Urinal <br /> Gas Piping Boiler Z Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration l Shower Floor Drain. <br /> Gas Fireplace Wood Stove 04, 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 SYSTEMS <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 befo -being authorized under any circumstance.I am the owner,or lam authorized by the owner of this properly to perform the work for which application is made, <br /> and I comply with th=State Contractor . , 8.27 R/ an.296.200A WAC. <br /> City of EverettOfficialUse Only <br /> /fr 5' 2 1 / PERMIT#/0/ \V Oh-- 0)-c --- <br /> Owner/Authorized Agent Signature Date l/`,fl'J, (Revised 10/12/2015)111 <br />