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PERMIT APPLICATI— <br /> BUILD>M I / MECHANICAL/ PLUMBING /SIC PRINKLER/ DEMOLITION <br /> /111"Pe.,„,...-.4 <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov i www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 373 1 V.,(06.4.4 cG g je PROPERTY TAX#:0/06,0506-00c, ler) <br /> LEGAL for new construction: Short Plat/subdivision / Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: pipe pe t, I TENANT NAME(If Commercial):+ �� eicT any _ <br /> OWNER MAILING ADDRESS: STREET 4-3132 W�91.-C t,� <br /> -(ige l„14 CITY tA) 14- STATE QUO,ZIP <br /> OWNER PHONE:, 25 -26-5 'cry OWNER EMAIL: mc1044-,f 0 "&r),n1-,,ipauzii,Zv►,v,.eelvi <br /> CONTRACTOR NAME: p.1i ,1” 1,004t <br /> CONTRACTOR ADDRESS: STREET ?7ZCo rlao6/ GJtcy <"C>Lk 3C ( M/''� <br /> CITY �41 STATE V,- " - ZIP 4O <br /> CONTRACTOR PHONE:4>c- 7_l 7—77/0 CONTRACTOR EMAIL: el,/r 0 1 u t ,-6C) `Cum <br /> CONTRACTOR LICENSE#(REQUIRED): ftg L(A F 7c 6s" CITY OF EVERETT BUSINES LICENSE#(REQUIRE (5 67 <br /> PRIMARY CONTACT: 0 OWNER ir2Z.ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4 � - - 307, <br /> j ) / LiG uicA CONTACT EMAIL: /e e.-~ f ?&C.I . eviAi <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: e---6 ,tL Contract Price of Work:$ 7,L9� <br /> Proposed Use of Building: 7444 Heat Source: teraas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family#of Units: commercial 0 Industrial <br /> Type of Project: ❑New DAddition aUemodel DRepair DTI. DSign DSprinkler ❑Demolition ❑Change of Use _ <br /> DESCRIPTION OF WORK: I 044 �� o <br /> Tern 5✓ 5, G4-Ilu..4- exist, <br /> 1 t (Cs Arne-. !'-ee,1 i-cet." <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <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 /> 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 before 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT#b <br /> (SD 4- V/"(1.4 4_1 ;a2e , <br /> Owner/ rized Agent Signa u Da (Revise.° 3/0 . <br /> I ii <br />