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IT <br /> tit <br /> t ipo. <br /> r.UILDIIW ! MECHANICAL/ SIGN / RINKLER� / DEMOLITION <br /> ,e414044•401/11v <br /> ' • <br /> `,M1/ CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 I(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (1-lane or -lack Ink Only Please) P•OJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: '312.1.-{ W, Won, r. f 6 t,A, D PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> env STATE ZIP <br /> OWNER PHONE: ) /�.t�tG OWNER EMAIL: <br /> -4 CONTRACTOR NAME: gf��t t l4N stz,e(itaa 3-V4 fe-- <br /> CONTRACTOR ADDRESS: WI- <br /> STREET 2Z g. ,4(4. A <br /> / f /y� <br /> • CITY '-,Q - i.' STATE ZIP / a��r,, <br /> CONTRACTOR PHONE: V:2:5) oil J 6®1 CONTRACTOR EMAIL: (\Cjad I 44�at, C jc1p 19 <br /> CONTRACTOR LICENSEEQIRED): 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 /> OD <br /> Existing Use of Building: Contract Price of Work:$ b 110D <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> uilding Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> pe of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> x D SCRIPTION OF WORK: R( CiW �iica rk/0 <br /> VOA/VI 2R914(-- it hi*g <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 61-102-0 (p <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 #°f 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/SUPPRESSION SYSTEM <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 /> cum-.t 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 /> B ldin. Official before bei .authorized under any circumstance.I am the owner,or I am authorized by the owner of this properly to perform the work for which application is made, <br /> a .I co 'ply with the Stai Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> --is ,.! thili <br /> ' PERMIT# O <br /> / -.._� , I <br /> Own r/Au� _ <br /> rized A. S nature Date (Revised 9/23/2016) <br />