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OIL BUILDING/MECHANICAL/PLUPERMIT APPLICATION <br /> MBING /SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> : ' >::" k, %, , �7 4_ - t PROJECT SITE INF MATIO4l1r..: ,,.,.., . T °ifi f 1 „ pry" <br /> PROJECT SITE ADDRESS:(',[1T', (/1 o ./-v' "'RROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision i \' Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION= .�-n' 'NA-L <br /> OWNER NAME: �I S('4 IA,in /��' (�/Q'� TENANT NAME(If Commercial): f7 <br /> OWNER MAILING ADDRESS: STREET (� '((/ `� l.I-I1/r. /p <br /> CITY <br /> �.ia -k C/0. STATE IA)A- Zl o 3 <br /> OWNER PHONE: 1.,�'-�' - .51/43- 1 k OWNER EMAIL: if <br /> CONTRACTOR NAME: g\. l/v.X , n6,..,,,,,,___) <br /> CONTRACTOR ADDRESS: STREET 'I It,LQ v ,4) SO---I v 6 ") -14----I A (x, <br /> CITY M. L/, STATE kJ ZIP V ��1 <br /> CONTRACTOR PHONE:LF2 z 11, • 1 1 CONTRACTOR EMAIL: in L Cl <br /> CONTRACTOR LICENSE#(REQUIRED) ei$3S VERETT BUSINESS LICENSE#(REQUIRED)052 0 <br /> PRIMARY CONTACT: 0 OWNER ONTRACTOR 0 OTHER(Please Specify) <br /> CONT CT AME: • CONTACT PHONE: I 7 '1-1( .1 I <br /> /-• i <br /> . ►V Vf j /( <br /> I I � W I CONTACT EMAIL: in 1 <br /> -Azi v- BUILOIN"GPERMIT,APPLIGAT-ION "F. tt '''','F'''''."'-'57,77,_-ti -2- <br /> Existing <br /> L3} <br /> Existing Use of Buildin •• Contract Price of Work:$ `-f 2j(� l/ <br /> Proposed Use of B 'ding: Heat Source: ❑Gas ❑Electric ❑Other 0 6 O <br /> Building Type: SFR-Detached ❑SFR-Attached 0 Duplex ❑Multi-Family-#of Units: ❑Commercial 0 Industrial <br /> Type of Project: El New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Li i V\ VA,Ce)V* tAA/17- 1.(. 4. di\AAATT- 6-11- ---. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> ,, MECHANICAL=PERMAIAPPLI,CATION PLUMBING.'aPERMIT,APPLICATION ",'' <br /> a <br /> Type of Project: _New _ Add9k,___Alteration _Repair Type of Project: _New Addn _Alteration _Repair <br /> #of #of List of Fixtures List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> t. 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 /> S000:CLER"I"SUPP'R SION SYSTEM ". <br /> Number 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.lam 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 /> ` �u / '1 <br /> PER v� 2 —u60 <br /> Owner/Authorized AT Signature Date (Revised 10/12/2015) <br />