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PERMIT APPLICATIO(-•• • <br /> BUILDIIII'� J MECHANICAL/ PLUMBING /SIGN I U� RINKLER/ DEMOLITION <br /> *'l' CITY OF EVERETT PERMIT SERVICES <br /> *AliW 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 !(E)everetteps@everettwa.gov! www.everettwa.gov/permits <br /> : „.` PROJECT SITE INFORMATION . <br /> PROJECT SITE ADDRESS:// PROPERTY TAX#: <br /> U/ Jff h i M/K. CA-1S--3/7 oO- G 20 oc <br /> LEGAL for new construction: Short Plat/subdivision I�(.2.,-)-.0/41-C,CO Lot No. 2., (attach copy of long legal description) <br /> ;CONTACT INFORMATION <br /> OWNER NAME: Rv57,42.4 C.Li 9(011 Cc3 $7`/,t/(. TENANT NAME(If Commercial): //A '7 <br /> OWNER MAILING ADDRESS: STREET ,Y 0 • )x /2.e/`�' <br /> nmocs1iJf ( CITY STATE (rte/ .. ZIP 1632 70 <br /> 2 <br /> OWNER PHONE: '- r-57& E,5 1 OWNER EMAIL: 19--/f-p&/-(0P-[FS�'� t+� �/`'/// /L• G U/"( <br /> CONTRACTOR NAME: &5T7/th C-) <br /> CONTRACTOR ADDRESS: STREET r 2(....), rb C3,`Y P2 7 3 <br /> CITY G� y5i/A4 £ STATE tie_Z ZIP 7E127C) <br /> CONTRACTOR PHONE: 4725--876 •65'7-7 CONTRACTOR EMAIL: li1/1/4/l0,z f9 6 ‘:4///. (oar <br /> CONTRACTOR LICENSE#(REQUIRED): ,/j c> CC 9) r CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):©5.333 <br /> PRIMARY CONTACT: 0 OWNER fitCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L•(2.tr' (9 7/ 6S <br /> i9/7 v� 6- CONTACT EMAIL: Q <br /> BUILiDINO:PERMIT APPLICATION <br /> Existing Use of Building: Yn-(./(7,1 Contract Price of Work:$ (:x'> 4 <br /> Proposed Use of Building: )Ci4 L,/ S Fie Heat Source: c;�Gas El Electric DOther <br /> Building Type: EISFR-Detached .$gR-Attached ODuplex ❑Multi-Family-#of Units: ClCommercial ❑Industrial <br /> Type of Project:J&New ClAddition ©Remodel EIRepair DT.I. CDSign ©Sprinkler ClDemolition OChange of Use <br /> DESCRIPTION OF WORK: C S/,tU cy 10��J 5�-- • <br /> WL :'- g5 <br /> 23 ?? �. ? tr.�`� 1 t Pi�. <br /> /J <br /> 6/417e-TED BUILDING G PERMIT#(if applicable): <br /> ASSO <br /> MECHANICAL PERMIT APPLICATION - ;... PWMBING PERMIT:APPLICATION. • <br /> Type of Project:9(New Addn Alteration _Repair Type of Project:&New Addn _Alteration _Repair <br /> #of #of #of #of <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump 3 Toilet / Backflow Preventer(Inside Bldg) <br /> 1 Forced Air Systems Unit Heater Bathtub -" Urinal <br /> Gas Piping Boiler 1-/ Lavatory(Wash Basin) Drinking Fountain <br /> j 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 ,V Laatettlea1a ' - - Other: <br /> S Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> /4/ I-I A)f /itfit, <br /> `;SPRINKLER/SUPPRESSION SYSTEM fl r2df—rr!'L <br /> Number of Heats <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,orf 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 /> _ PERMIT# <br /> WRQP___XA0,3A/1) s _ 2.3-14 �i1(�0(Q_ 01(0Owner/Authorized Agent Signat Date (Revised 10/1212015) <br />