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OLT PERMIT APPLICATI` <br /> BUIL= /MECHANICAL/ PLUMBING/SIG 'PRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only;'Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 4 0 ROCKag 1 ,l PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION .. . <br /> OWNER NAME: TENANT NAME(If Commercial): e"vrt i . f ,, <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: FIPI)I sxrt t b 1'� v) [OW <br /> CONTRACTOR ADDRESS: STREET 2,1 R,'C%t,v%eFe.P—f—E,, k. hve.. <br /> CnY EVA 1 ( STATE ZIP 12,2. I <br /> CONTRACTOR PHONE: 5i• b . CONTRACTOR EMAIL: j p)'«. i <br /> CONTRACTOR LICENSE#(REQUI D): ) CITY OF EVERETT BUSINESS LICENSE#(REQUI D): <br /> PRIMARY CONTACT: 0 OWNER El CONTRACTOR `OTHER(Please Specify) t`N$.VATI <br /> CONTACT NAME: CONTACT PHONE: 4a artco,- <br /> L. L. Y N410.4,. CONTACT EMAIL: („04,\c i L,+ Clip N‘i <br /> BUILDING PERMIT APPLICATION zgo <br /> Existing Use of Building: Contract Price of Work:$ y <br /> Proposed Use of Building: fiA7GYT1 zzote.( fl4 ?(e1/ Heat Source: ❑Gas %Electric DOther <br /> Building Type: El SFR-Detached @SFR-Attached ❑Duplex OMuIt-Family-#of Units: iikCommercial CI Industrial <br /> Type of Project El New DAddition El Remodel ORepairi'.I. ❑Sign El Sprinkler ❑Demolition El Change of Use <br /> DESCRIPTION OF WORK: s , , . a <br /> Mie,(, t,�vc�9 k Q\U ,lot - TI -`t. f- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn y, Alteration Repair Type of Project: _New Addn VAlteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures F' ures Fixtures <br /> A/C—Air Handling Units Heat Pump t Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater �1 Bathtub Urinal <br /> Gas Piping Boiler (3j Lavatory(Wash Basin) Drinking Fountain , <br /> Water Heater Refrigeration 6)4"' Shower Floor Drain <br /> Gas FireplaceWood Stove I Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> 9 Clothes Dryer Hookups Other: 00°` Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other:0 <br /> Reidoexre TOIL-el- <br /> , <br /> SPRINKLER I SUPPRESSION SYSTEM / <br /> Number of Heads <br /> ACKNOWLEDGEMENT:l 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.l am the owner,or I am authorized by the owner of this properly to perform the work for which application is made, <br /> and I comply,'th the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> T� <br /> OFel/d <br /> m�'' // / PERF ..... <br /> CP C c '-C O 2---=_....JuAAgent Signature D e (Revised q u77) <br />