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op <br /> PERMIT APPLICA`PIO <br /> Q91L®II 1 MECHANICAL/ PLUMBING !SIGNPRINPn'LER/DEMOLITION <br /> 41/411p0 +" 1 CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or :lack Ink Only Please) i Pr ii)J CT SITE INFORM 1. •N <br /> PROJECT SITE ADDRESS: _ '��IL=-tl �i:ROPERTY TAX#: <br /> v <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ' <br /> CONT ,CT INFORMATION <br /> OWNER NAME: f4J) X71, 1 ��p " I�' 'T NANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3 /I i 4 kg... /JiL cit. (9a <br /> CITY ] - Li - STATE _9.0, n ZIP C06 <br /> OWNER PHONE:( 2 ') 1-51 e2.05 OWNER EMAIL: P' /<l .J i AL- `n'"1 <br /> CONTRACTOR NAME: Ski - gotau ayt,x, = I `-.* ILC- <br /> CONTRACTOR ADDRESS: STREET y ; ((OF- E AllE -S PI /yam • <br /> CITY STA. ZIP / 0 <br /> CONTRACTOR PHONE:(t2) �8 - CONTRACTOR EMAIL: /ft `(a '' _r'\ <br /> CONTRACTOR LICENSE#(REQ"UIRED): C,.� 35-14) CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): �7 <br /> PRIMARY CONTACT: 0 OWNER ,CONTRACTOR 0 OTHER(Please Specify) (qZ�) ! 115 Y7 <br /> CONTACT NAME J CONTACT PHONE:� 1 <br /> I - CONTACT EMAIL: r 6 f� i4C6 6-1 <br /> 11r9 BUILDING PERMIT APPLICATION - <br /> Existing Use of Building: /11(r--1714t410- Contract Price of Work:$_ ^ Roo <br /> Proposed Use of Building: .�E. Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ' Multi-Family-#of Units: ?ti: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition emodel ❑Repair DTI. ❑Sign ❑Sprinkler , ❑Demolition ❑Change of Usg% <br /> DESCR�I,P ION OF WORK:,_ .. _ li '1,..___tiAar. .,-.,.,,t1c fie_ tatecriweis to/itiau \-ri,wes/ f,44) <br /> V-4 jL&JJ' f - l6 SiI NC- ,-,-,A413 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): & 1102-1)21 <br /> MECHANICAL PERMIT 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 #of List of Fixtures #of 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/SUPPRESSION SYSTEM <br /> Chemical or Water 1 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 befor-being aut orized 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 /> and7 <br /> mply with the r tate Con •ctors Law 18.27 RCW and 296.200A WAC <br /> f I' /� r-a • <br /> City of Everett Official Use Only <br /> lw. i �li �1��11 r"V� '� I12-1 j' FERMI # 0 <br /> I/ <br /> Own '/Aut orized Agent ignature Date / (Revised 9/23/2016)` <br />