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t <br /> PERMIT APPLICATeirfr <br /> BUIL /MECHANICAL/ PLUMBING /SI el-'�— PRINKLER I DEMOLITION <br /> miliWilCITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettvra.gov I www.evereftwa.gov/permits . <br /> (Blue or flack Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: '13W LAU Foil-NIA 4—'VT PROPERTY TAX#: ex)i-3-riudo decoct, <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)t./...- ' <br /> CONTACT INFORMATION <br /> OWNER NAME: ,DI tJM,l44 6o4W-ry1 -N--..--4), TENANT NAME(If Commercial): ' 4OH'OMI9j( Cmtr, <br /> OWNER MAILING ADDRESS: STREET 2^32.0 (rgFr,j �, A <br /> CITY gVgj'YL4 STATE Wk-v ZIP (Q <br /> 45 2.049 <br /> OWNER PHONE: 11-2.r-7S3.r� 00+' OWNER EMAIL: vd,.......4 v �giNp i, eorA, <br /> CONTRACTOR NAME: 'MCC)'MCC) COM rAk4I W..) L .& <br /> CONTRACTOR ADDRESS: STREET lI:5014, y4r.,1. (Ai I Levo i4 , <br /> U t <br /> cmTY 15UP &-tiTo` ► STATE i ZIP 1$233 <br /> CONTRACTOR PHONE: jØ , M —sit-7fiCONTRACTOR EMAIL: SONAr,L44Cocows ; FFF <br /> CONTRACTOR LICENSE#(REQUIRED):1'Y'IGOce/MIS CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Z''12,1_„ <br /> PRIMARY CONTACT: DOWNER 0 CONTRACTOR ' 0 OTHER(Please Specify) <br /> CONTACT NAME: /� CONTACT PHONE: S`,/8•3•-• ot+ <br /> . t`rV I 1"V 12®14kw CONTACT EMAIL: 9a,IM a►GP4Dh,a i" rJ.s tcpw r4, c✓1e,, <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: orrt E Avadzeliruse Contract Price of Work:$ •I+'M a OO <br /> Proposed Use of Building: O4 IC.E/WheVie l44E Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial ❑Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel repair ❑TA. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: / <br /> P l'iAf- efleAlt46t C°1444 -rt PAW-1Z- -rAtta. wrrft 1, µOa Caov (oI.othLA <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 /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of 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 /> + <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 /> 154 City of Everett Official Use Only <br /> of-- O—/ . PEf ,gD S-- ( <br /> Own r/Au orized Agent Signature Date (Revised 9/23/2016) <br />