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PERMIT APPLICA 11111 a <br /> BUILD>� /MECHANICAL/ PLUMBING /SI SPRINKLER/ DEMOLITION <br /> 40#1011Ville"-APill' <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 Black Ink Only Please)_: ; PROJECT SITE,INFORMATION , " . <br /> PROJECT SITE ADDRESS: //' PROPERTY TAX#: 1S9 O7/1 0(( <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) &A <br /> . CONTACT INFORMATION <br /> .� I <br /> OWNER NAME: �' r lA#2J/•f 'i' " i1 TENANT NAME(If Commercial): <br /> V <br /> OWNER MAILING ADDRESS: STREET 6,3o 3, ...4-...2 hr. C.F.✓ /� <br /> y/ CITY e � STATE ' ZIPq �J lJ <br /> OWNER PHONE: t2 Oc " 3O7�— �6O1 OWNER EMAIL: kA 6,s& 4- "i 1 rA-�.._.. <br /> CONTRACTOR NAME: - 0 Lc <br /> CONTRACTOR ADDRESS: STREET '4'►'�..„ <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR PTHER(Please Specify) " 4 <br /> CONTACT NAME: `1"� � Ba 3� (9/ CONTACT PHONE: ,2,c, 3 — 4(t, — 7C, <br /> ' 144 is &' r CONTACT EMAIL: (kiela 4 ea 1k, C, `" ,,, -. -. <br /> . BUILDING PERMIT APPLICATION : . <br /> Existing Use of Building: 1—C," Contract Price of Work:$ ,t-,,,eretre.3 <br /> Proposed Use of Building: f P Heat Source: ❑Gas efileotric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: commercial Ellndustrial <br /> Type of Project ❑New ❑Additionemodel ❑Repair DT.I. ❑Sign ❑Sprinkler ❑Demolition El Change of Use <br /> DESCRIPTION OF WORK: 4 Itob <br /> ASSOCIATED BUILDING PERMIT#(if applicable): �'�' �GG��G� "' <br /> y <br /> M,ECHANICAL'PERMIITAPPLICATION 'Xi/i' PLUMBING PERMIT'APPLICATION ` <br /> Type I _ RepairTypeProject: _ Alteration _Repair <br /> T e of Project New Addn Alteration of _New Addn . <br /> #of #of List of Fixtures 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 I SUPPRESSION SYSTEM <br /> 'Number 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 before being authorized under any circumstance.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> b <br /> Owner/ horized Agent Sign: ure "�ate (Revised 9/23/2016) <br />