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RMIT <br /> BUILDING MECHANICALS/ PLUMBING CS GNSPRINKLER/DEMOLITION <br /> � CITY OF EVERETT PERMIT SERVICES <br /> !'Nitif 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: 0(96 SE EEe i!Ur c'e /(t 7 -/d 44--PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 'RAbGVN ( R-opQv Q. TENANT NAME(If Commercial):— `BVI S/ V ScQ <br /> OWNER MAILING ADDRESS: STREET C 00 SS. <br /> . ,� Vi'(e< I I (23(%c Y - <br /> CITY Q{/' - STATE I(...c..,) ' ' e, zIP 9%QC) (� <br /> OWNER PHONE:t<(aS- 33 3 R veC) OWNER EMAIL: <br /> CONTRACTOR NAME: 06j-(A 'S-ii SfelAAS 1 <br /> CONTRACTOR ADDRESS: STREET 1 , 11_j'3 pi SC.(J <br /> CITY Lyn U 3 d(9 STATE ( 0,9- ZIP 9T.v%r'9' <br /> CONTRACTOR PHONE: (G CONTRACTOR EMAIL: 0,0(3-(A Gt.lPcC,� (�� U�y� t C'Ulm <br /> CONTRACTOR LICENSE#(REQUIRED):t\ -(:)N S144. ��b CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):# d 9t' <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) St*C,to icor c9--r <br /> CONTACT NAME- CONTACT PHONE: (,I a y-3sr3 --`i 1 7 <br /> /--(2- 11-$ CONTACT EMAIL: IS i` y @ gQ 1,4QU Q Vj: (961AA <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 4'00 <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 DAddition ❑Remodel ❑Repair ❑T.I. Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: L y, 1 <br /> l�5k)( 0C IQ JP S { kiPR Illt4 ( / <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 /> ��� 1 PERMIT# 5 t ,306 +�,, <br /> Owner/Aut ized Age Sign re Date (Revised 9/23/2016) <br />