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IIIIII PERMIT APPLICATI <br /> ow :UILDI4 1 MECHANICAL/ PLUM.:-INO /SIG . . RINKLER/ DEMOLITION <br /> 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) , PRM C`i�SITE INFO TI I N <br /> . . <br /> PROJECT SITE ADDRESS: jt WO !t.6 i ( PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> _. .. <br /> CONTACTI <br /> ®RMATI®N <br /> OWNER NAME: G15iii;J LIXc itee"d( Fj� - (C 'aTENANT <br /> NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET iat (/i"Pt4j1 )JL - (0a- (• <br /> CITY °'7t Li if_ STATE STATE _4r A -/ A ZIP ( J <br /> OWNER PHONE:02-0 t tiZ$ OWNER EMAIL: t' i t+-t `'9Ii is <br /> CONTRACTOR NAME: .5 - aattoU a t - /'-( __/ --�5'W <br /> Ur— <br /> CONTRACTOR ADDRESS: STREET <br /> Oki...LOX-6f_ <br /> ; az"- tv P • <br /> CITY STAE- W4 zI—P- e <br /> il <br /> CONTRACTOR PHONE:(_`tj2S) VI --(2 CONTRACTOR EMAIL: -Ilai� �-�1-; _ ' _{{''"��0 <br /> CONTRACTOR LICENSE#(REQUIRED): • C--,...q335k8 CITY OF EVERETT BUSINESS LItCENSE#(REQUIRED):( j .S <br /> PRIMARY CONTACT: 0 OWNER ,CONTRACTOR 0 OTHER(Please Specify) f .ZS- [ l K�s2 <br /> CONTACT NAME• 711 <br /> P144,4A) • CONTACT PHONE: ,..cbet }6CONTACT EMAIL: r 4 /�C�t C nC�` i <br /> ,�d BUILDING PERMIT APPLICATION J - <br /> Existing Use of Building: /16(4-171/161/C5 Contract Price of Work:$. 9112,4) <br /> Proposed Use of Building: •4114E- Heat Source: ❑Gas DElectric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex Vlulti-Family-#of Units: 9Ci:% DCommercial ❑Industrial <br /> Type of Project: ❑New DAddition Pkemodel ❑Repair Oil. OSign ❑Sprinkler , ❑Demolition ❑Change,of Use, <br /> DESC IP ION OF WORK: <br /> tie— AVC--P446 bt/Adt,U .rAtteS /1,4 <br /> V ' +moi.&k1 f m/6 S LckiL q-1-0.48' <br /> ASSOCIATED BUILDING PERMIT#(if applicable): Pi.r(0272-11, <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 /> NC-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 /> ifWater 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 INo.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 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 .amply with the state Cons actors Law 18.27 RCW and 296.200A WAC. <br /> �� b /' City of Everett Official Use Only <br /> Mi , ..., . • --- - 'S,6-Icy E+(.471 j 9-1,k .... oG -"- <br /> Owns/Aut orized Agent ignature Date (Revised 9/23/2016) <br />