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BUILDINA/MECHANICALS/POLT— ILUMBING I SIG SPRINKLER/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 1 www.everettwa.gov/permits <br /> (Blueor Black Ink Only,Please) ;PROJECT.SITE INFORMATION <br /> PROJECT SITE ADDRESS: RUCkGEEFR f\/e avaZe..Tr uhlk 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): T!-i'E. j }A` ;..5 <br /> OWNER MAILING ADDRESS: STREET <br /> CITY - STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: H bFF 'F*p)►vATi I J t'Y AI II W <br /> CONTRACTOR ADDRESS: STREET 2../u0 �.��.Et�t.•i-kgs �Va_„ <br /> CITY GV '! "j"T° STATE t,(, , ZIP C15 , <br /> CONTRACTOR PHONE: / - CONTRACTOR EMAIL: Vf.(OF'r:,pchit4PA.T <br /> CONTRACTOR LICENSE#(REQUIlti CITY OF EVERETT BUSINESS LICENSE#(REQUI D): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ' 9THER(Please Specify) orF )P.t17ATtt 4 <br /> CONTACT NAME: CONTACT PHONE: 41,6.8,7(o 917 <br /> mpNCONTACT EMAIL: L1e01,6,01,411, Ion <br /> BUILDING=PERMIT,APPLICATION,. ,, <br /> Existing Use of Building: Contract Price of Work:$ 10 I 0000° <br /> Proposed Use of Building: ?C)1 I eq0 (e0146,14,6 6, Q(o EHeat Source: ❑Gas %Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: "commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel El Repair .1. El Sign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 's►•AN,4I.tor j(1/4,4I `ROV laNT'� <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 #°f List of Fixtures #°f List of Fixtures #°{ 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 I'` Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting ®" Dishwasher Roof Drains <br /> k Clothes Dryer Hookups Other: C Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> 4,, Exhaust Fan Sink(Service/Bar/Mop/etc.) Other:# <br /> RIEI~Te TO1 L..r <br /> SPRINKLER%;SUPPRESSION SYSTEM L.ei+.V <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.I 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 /> ,I /71 //-5/ <br /> ;� PEF1rP�!T coe <br /> 177--r Au orized Agent Signature D e (Revisea 5/20/2016) <br /> 1 <br />