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III I I I PERMIT'APPLICATI - <br /> UILD 7 MECHANICAL/ PLUM r:,ING /SIG°�. --RINKLER/ DEMOLITION <br /> /rf 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.govlpermits <br /> (Blume®e -1lack Ind Only Please) , PR•J CT SITE INFORMA110 <br /> PROJECT SITE ADDRESS: - 24 ( CAS 1,f°U`O Z- &L-F PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> — <br /> CONT CT Ilr,ORMATION <br /> OWNER NAME: C,ks440 ( •i`(;` 4)0E- ' T NANT NAMEME�(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 22 3 //2,74-- 4(J - /JE g11 oz- <br /> (CITY j (��_ STATE _L � � ZIP ?ecu, <br /> OWNER PHONE: 2g) L y (Z OWNER EMAIL: /t '`►`-k L ) At vt.__ -- <br /> CONTRACTOR NAME: .,S - 004(6-‘1Jw t ° / / - /.tit— <br /> CONTRACTOR <br /> . <br /> CONTRACTOR ADDRESS: STREET S az:1 F /V -.1 ( 2_ (/U/� /��r8/� <br /> CITY Aka V STA ZIP /E0 <br /> CONTRACTOR PHONE:(1,2) Igt3CONTRACTOR EMAIL: /�z1lrn�s\ s ' _ <br /> CONTRACTOR LICENSE#(REQUIRED): G� 35Y4O CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER )CONTRACTOR 0 OTHER(Please Specify) <br /> /./. >t--\ <br /> WW I G lly J <br /> CONTACT NAME facip,,,„1 f + J C� (P.,,,g) � <br /> CONTACT PHONE: ! j <br /> SS�v I t(L l CONTACT EMAIL: r IG (`beacc :net <br /> J <br /> an BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Clitk-ilvitilic5 Contract Price of Work:$. <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex gulti-Family-#of Units: 9t) ❑Commercial DIndustrial <br /> Type of Project: ❑New DAddition 19 emodel ❑Repair CT.I. ❑Sign ❑Sprinkler . ❑Demolition ❑Change of Useh <br /> DESCRIPTION OF WORK:_ -is-r4, , ---.4.gir-c,W fie-- witt-c'TA046 ti9/Aiatj rAtir-c'. f:44- <br /> 4-4 c �J f S'�L mrL �1 , <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 1362---.72--- <br /> MECHANICAL <br /> 2-32---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 #°f 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 /> t 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 itate Con,actors Law 18.27 RCW and 296.200A WAC. <br /> Wi . City of Everett Official Use Only <br /> �1/�(�,G� y, , ( _ (#qct c) -3 <br /> :1 <br /> Ownd/Aut orized Agent ignature`� --fif Date (Revised 9/23/2016) <br />