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II I PEI-MIT APPLICATION <br /> '/0/ 4'-- <br /> BUIL.®IR��/ MECHANICAL/ PL UMBING 1 SIG /SPRIN LER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 5 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 =;lack Ink Only Please) PROJECT SITE INP®':NATION <br /> PROJECT SITE ADDRESS: .2' 4 PROPERTY TAX#: d� 3 �/7 3 <br /> LEGAL for new construction: Short Plat/subdivision <br /> ubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: b/ It1,,RL ri iw LLL TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET R )3 o A 5-z 6 Lf/ <br /> CITY 13E2-, STATE WIC- ZIP ele Cl .)---- <br /> OWNER <br /> OWNER PHONE: 2 (t1 228 0 53 6 1WNER EMAIL: 3/'/41/. VP L c'7v17 4, p /4 fes"4..... c ,/-t <br /> CONTRACTOR NAME: P/'-vL 0ANA I pG�'7L3Pkr?a c7 F tev-4 i-r /V//-v? cc4„,,,,,r`'' <br /> CONTRACTOR ADDRESS: STREET f.5-e:70 9 3S-71-i ,4✓� wv- ,S /t <br /> CITY li y/ Gtr2,ix*) STATE (/✓A ZIP GJy067 .7 <br /> CONTRACTOR PHONE: Zv 6 3 6/3 , OZ. CONTRACTOR EMAIL: ' <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: • Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair DT.I. ❑Sign ❑Sprinkler El Demolition El Change of Use <br /> DESCRIPTION OF WORK: <br /> A-t,D f x T--? n' & j s 77 A/4 p /°-‘G 7- ed $--- D/ O <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn Alteration VIRepair Type of Project: _New Addn _Alteration —Repair <br /> #of List of Fixtures #°f List of Fixtures #°f List of Fixtures #of List of Fixtures <br /> Fixtures . Fixtures Fixtures Fixtures <br /> NC-Air Handling Units Heat Pump /R pf1Ef'oilet Backflow Preventer(Inside Bldg) <br /> / R Pagil Q Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration / A&-h/Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> / /Wive' Gas Range Ducting / emu(Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: • Clothes Washer Medical Gas <br /> / aa/ Range Hood Water Heater Other: <br /> keyx/ Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> / Oppt1rtr il`r 87!/ <br /> SPRINKLER/SUPPRESSION SYSTEM 17. . . , <br /> Chemical or Water I No.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.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 1 comply w' – e State Contractors Law 18.27 RCW and 296.200A WAC. <br /> .., City of Everett Official Use Only <br /> PERMIT# <br /> 7 6.,--�z---- N_ itia du. e, (705- l <br /> ner/Authorized Agent Signature Date (Revised 9/23/2016) <br />