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PERMIT APPLICATICIf <br /> BUILDIN:ECHANICAL/PLUMBING/SIGI RINKLER/ DEMOLITION <br /> #40'1.14-1°"i'-- 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:''5003 east yt. ,eel ; jpe.A (4O'-2 PROPERTY TAX#101/00j <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Coe,t- CQS TENANT NAME(If Commercial): �f ° 0 <br /> o &i t 3707 6A-1 -61 <br /> _ ` tet, <br /> -..K- <br /> MAILING ADDRESS. srFteEr / <br /> CITY S A ``STATE (J <br /> ZIP q wiz, <br /> OWNER PHONE: gr](,r �C)i{ OWNER EMAIL: IIIA Q.Ja1A-Aalrek-S-r 45),- ,rev <br /> ,6 cs <br /> CONTRACTOR NAME: i <br /> CONTRACTOR ADDRESS: sTRE (,,[)p S i 7j <br /> Cm' Q STATE COs. ZIP gmV <br /> CONTRACTOR PHONE:2)(125D t f s CONTRACTOR EMAIL: (1,pm,Y1,typ 1 E ''- P ,444.►_. <br /> CONTRACTOR LICENSE#(REQUIRED): 1 � &Y� '�'CITY OF EVERETT BUSINESS LICENSE#(REQUIRE i 3 <br /> PRIMARY CONTACT: 0 OWNER ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: 11 CONTACT PHONE: 46, a 4 C <br /> 01)ifllAt ``et t"'�Iririlt if CONTACT EMAILOAA A 11P1f I Cs <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ / ` 7 <br /> Proposed Use of Building: Heat Source: °Gas ❑Electric ❑Other <br /> Building Type: °SFR-Detached OSFR-Attached ❑Duplex °Multi-Family-#of Units: OCommerciat °Industrial <br /> Type of Project: °New DA clition °Remodel °Repair OT.I. °Sign ❑Sprinkler °Demolition °Change of Use <br /> DESCRIPTION OF WORK: 4 u, r, a te-,C.400 ` romw <br /> a. *2,4444.42,1- .11. -- rov`f rvw)I\ <br /> 3 ul rL- sw. . --1-6 u, A-Mu ic raeiop vA' ' 0.-„,0 . <br /> ASSOCIATED BUILDING PERMIT#(if applicable): (3 1O 6--(-)C4 h <br /> MECHANICAL PERMIT APJ'LICATION' 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 #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> 1 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 1 Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas Y <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 lam authorized by t _wner of this property to perform the work for which application is made, <br /> and/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> /"'y' \1), City of Everett Official Use Only <br /> (N(t.... 1 , 1 ` PERMIT <br /> 1 ) I /C'S . 021 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />