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PERMIT APPLICATlOIN - ant k <br /> BUILDII IIIECHANICAL/PLUMBING/SIGN LII RINKLER/ DEMOLITION <br /> v„ 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:C 07 5g G cak- T mem., (Amy C-vt;ILE7r IM IPROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Loll (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ISA Lt12)01,1 Kb N TENANT NAME(If Commercial):M c we k tv i✓- <br /> OWNER MAILING ADDRESS: STREET .S 0 0 J itape r Ni ilt L-t. G t fi - Ar- <br /> err( UM--12"errSTATE WP ZIP q0 (N( <br /> OWNER PHONE: 42S. ;53. W400 OWNER EMAIL: . €i Nspi 3 tY - TMPrU,.(.Z>M <br /> CONTRACTOR NAME: 7WA Ait -- -44PR-o vM1 J7 C 6 // j2 S1rl B 1/4 ./ ,o <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR XOTHER(Please Specify) 'a1�'1.5-r <br /> CONTACT NAME: CONTACT PHONE: 14-2_,c . . s...---+. 14)54 <br /> CONTACT EMAIL: Ol.-0102-0g- Q„hDb,( W <br /> BUILDING PERMIT APPLICATION / <br /> Existing Use of Building: Contract Price of Work. ,� a <br /> Proposed Use of Building: Heat Source: El Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: •Commercial El industrial <br /> Type of Project: ❑New @Addition ❑Rem odel @Repair DTI. ❑Sign ❑Sprinkler @Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> New C bYvl oRX(Ar I -4-1-06.6/1 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): .-S:-.P1-67/6i.) -O-1 I' k \ .J� <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 Showery Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal 3 Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood 1.... Water Heater Other: <br /> Exhaust Fan 5 Sink(Service/Bar/Mop/etc.) Other: <br /> • SPRINKLER I 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 /> p City of Everett Official Use Only <br /> A q <br /> Lk�0(a •20►) TCr-40(4 ��/ <br /> Own /A Agent Signature Date (Revised 9/23/2016) <br /> Ei2—.), <br />