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PMIT APPLICATIO��► <br /> BUILDI MECHANICAL/PLUMBING /SIG�'RINKLER/ DEMOLITION <br /> CITY OF EVERETTERPERMIT SERVICES <br /> #1111. <br /> � � 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 J 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: 34/z-/ t aletlij 2.A�-esu e-, 6 VQretf PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision N/«- Lot No. (attach copy of long legal description) -- <br /> / CONTACT INFORMATION <br /> OWNER NAME: h?an/Jaye ithIes/De,/210 MS TENANT NAME(If Commercial): N/4._ <br /> OWNER/ MAILING,SADDRESS: STREET / 69 G� Pereyrrle A. e c+ <br /> /!i(L VV� - ci,-,O//O wit?Vecti 7"7 STATE WA- ZIP 9S 2-74/ <br /> OWNER PHONE. 3/ 0) A7/2--q" 6 6 Z 3 OWNER EMAIL: roYeci' V,7/a 3d Z @ 6,,o//. , l'Ryi2 <br /> CONTRACTOR NAME: if/4 O;J r._2Z-/ <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: 74 OWNER D CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE( 6 0) 5 /O • 7 7 E <br /> /eh aryJa y/7e W®/'eS CONTACT EMAIL: fore,c-1-(/l Wet l() i (d'7y/ <br /> . 1 <br /> BUILDING PERMIT APPLICATION <br /> �l r /) <br /> Existing Use of Building: /'�l',S/U� e Q Contract Price of Work:.', 000 C—“—.)___ <br /> Proposed Use of Building: XeS/a°ene e- Heat Source: Was NcElectric ❑Other <br /> Building Type: NSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: E -•- ial ❑Industrial <br /> Type of Project: ❑New DAddition Memodel Q[Repair DTI. ❑Sign ❑S[p_riinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Rem od I, r..e/7o va- - X/51r%1y 57-T .4 cf+ti e • /ec/RC. P Repc'r <br /> dated ¢ b ro/Cen fr-X eS. 0ce.hi/et5, .f/oor/, C•fcmfo&s, /K/ -tehe/i c +je-li <br /> rrmoclets- /anneela/14► 'iw /(ares .e � s E {-ix-lures) pada- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): fir'/'u/VJ rept/r' t• Ccrijc�e e-,O'M re/oct,i': f(e....14-0 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New_ Addn _Alteration 2LRepair 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 'Z Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater 2, Bathtub Urinal <br /> Gas Piping Boiler 2 Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration j. Shower Floor Drain <br /> Gas Fireplace Wood Stove j.. Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting 2 Dishwasher Roof Drains <br /> l Clothes Dryer Hookups Other: .3._ Clothes Washer Medical Gas <br /> 1 Range Hood a Water Heater Other: <br /> 3 Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/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 /> CCity�of/Evveerett Official Use Only <br /> (141Z17/16:6 <br /> L/1 1� PE MI� \ - 11J 3 ` <br /> Owner/Autth/on{gf ed A nature Date (Revised 9/23/2016) a" ' <br />