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14-7- DUILDINO 1 MECHANICALS/PLUMBINGCS GN / SPRINKLER,DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR TREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> .1k PROJECT SITE ADDRESS:411®') Qz c 7:::)r-Z,, PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: h' ¢, , G t;-x' ` -Z TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET49 109 1j�C,woe, 1'jj .
<br /> CITY�'Y'"It34Z STATE .� ZIP—7 J"\
<br /> OWNER PHONE'�-�-74:30 7:7 4 OWNER EMAIL: 6 v e c,,,,Z . �...,,.�
<br /> -4 CONTRACTOR NAME: l GU,A,c Al, eee Sj
<br /> CONTRACTOR ADDRESS: STREET.'"7471 l 2 t+3 /—U N?
<br /> "- 2W SVS t_CF crrY A/.p" STATE ZIPa?q..,..7.71CD
<br /> CONTRACTOR PHONE:4Z' )•3 1 9-,(^Zaf CONTRACTOR EMAIL: '-t-2,Gj N \I\/ 4161- y,,,�t,l , c-:-. v-.\
<br /> CONTRACTOR LICENSE#(REQUIRED):'' I (L) cei-Z—j "`S r� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: 0 OWNER AlZONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 4--�.'-, 9,_ ,,___55,---1
<br /> q `1gt",tLt...cL CONTACT EMAIL: 72,e_3?7\1 w C a7)>-vi A.(t—, Cc.zn---,
<br /> BUILDING PERMIT APPLICATION
<br /> Existing Use of Building: Contract Price of Work:$ \-)),Db0 e '`�
<br /> Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family#of Units: ❑Commercial ❑Industrial
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> I DESCRIPTION OF WORK: er�ov e ,L '�om .14� C ,. . s —` s-Lio1 Q <7 . 'W.o.zo
<br /> 4-Ler' `e'fz-Eil6t. — L,e."Z /.0 s�e�.4-T"i env -F"(:) C7Z 7€ IN'r i) ter g. F-t-c -' --
<br /> �e.....A.cE "Pk—L-P,(/c,=)-D syko r R, ivte',N _ /A)sr.1c_t_/Vt.Vcr 7(..C.,0..) ,v S-r=i /fri c. ;"s'
<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 /> NC—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 /> "".. ., 1111111",......min.—..- - 4'/ / )€.-,' PERMIT In 1 Q r �D 11.4
<br /> Own- ent Sign Date (Revised 9/23/2016)
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