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PERMIT APPLICAflOIIIIII <br /> E:UILDIIIII ) MECHANICAL/ PLUM':-ING /S GI�'7' RINKLER/ DEMOLITION <br /> *WICITY 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 /> (Blase or Black Ink Only Please) P .,�)J CT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 24 U l• WO ,;'�€ '1W - j.. PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONT CT 1 FORMATION <br /> OWNER NAME: QA$j ;d ( " (7I, LL '�-0r9- `' TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET jr �f i 4 4(1 OE_ i9� <br /> t- CITY .- STATE _ 1 ,,'9ZIPOWNER PHONE:y{z) L J V20.5OWNER EMAIL: t{ I /is /f"4 -. at( <br /> CONTRACTOR NAME: .5 - acitaitj aAiisc . /, /C `wr <br /> tic_ <br /> CONTRACTOR ADDRESS: STREET :}/��jj(��2��F�1JJJJffff((iJ� F AL --,1`� /01 JJ�� (1�.5��' <br /> CITY -�/`- STA VV ZIP /�l <br /> / n i <br /> CONTRACTOR PHONE:(, S) ta[ CONTRACTOR EMAIL: . jirri •)e-Dr/VC-4-q; ' _ _ °� <br /> CONTRACTOR LICENSE#(REQUIRED):/ C� 35{'4.P„) CITY OF EVERETT� BUSINESS LICENSE#(REQUIRED): +TAS <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify), (��_} i 4 <br /> CONTACT NAME- t (`,-� / Q CONTACT PHONE: � !•� jW <br /> POtid 't )15 1-tlG l ' CONTACT EMAIL: -o j j d <br /> f' 1/t O iCcZ <br /> ,., <br /> BUILDING PERMIT APPLICATION - <br /> Existing Use of Building: i Contract Price of Work:$, '6 <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex *lulti-Family-#of Units: q(> ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition cgRemodel ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change,of Us <br /> DESCRIP ION OF WORK: <br /> 1,s4,_‘7Tivb , ,q----tiAztc 1:46-r Wit-Cc:PO/a 0,Aditio MLA/ AAJ,R <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ti- �l <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 /> '9j 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 /> 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 /> and amply with the I tate Con -ctors Law 18.27 RCW and 296.200A WAC. <br /> i • <br /> A, City of Everett Official Use Only <br /> 1/21 1 <br /> Own /Aut orized Agent ignature Date (Revised 9/23/2016) <br />