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PRIT <br /> BUILDING/ MECHANICALS PMUMBING CATION <br /> IO /SIGN !SPRINKLER/ DEMOLITION <br /> * <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 severettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITEINFORMATION .- <br /> PROJECT SITE ADDRESS: "130 (.....:./ <br /> LEGAL For new construction: Short PlaF's PROPERTY TAX#: <br /> v-ubdiuisi' <br /> - Lot Jo. (attach copy of long legal description) <br /> q CONTACT INFORMATION <br /> OWNER NAME: ,�, nl.' <br /> / ( TENANT NAME(If Commercial); <br /> OWNER MAILING ADDRESS: STREE- ,7 —~ <br /> OWNER PHONE:'72 - 7" 77 STATE >� ZIP <br /> 9 e20.3 <br /> • OWNER EMAIL: <br /> CONTRACTOR NAME; . ' •f in L <br /> CONTRACTOR ADDRESS: 1 4' h//-;; /,�,tj � �_�� <br /> SIRE@ Cl4�S.,4.r4M,J .-, <br /> CITY goo. .. 44/10 '° ,r <br /> CONTRACTOR PHONE: Z�� STATE w A— ZIP f * 201 <br /> 5o CONTRACTOR EMAIL•' ♦,4 11 ,r R. fli CO <br /> CONTRACTOR LICENSE ft/REQUIRED): -� <br /> ilo /A• 118 CtfiY OF-eveRETT gUSINESS LICENSE tt REQJlRED; <br /> PRIMARY CONTACT: 0 OWNER L` ( ) f "t`p�`g <br /> CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> T^ �_p_ CONTACT PHONE: 4, 6 259' 055 <br /> Lf�i('yV� CONTACT EMAIL: a` a 1 aiivi.kg • I Co <br /> BUILDINGPERMIT APPLICATION -' <br /> Existing Use of Buildin <br /> Contract Price of Work: $ <br /> Proposed Use of Buildins: <br /> 3uildin« T e. .F Heat Source: ❑Gas Electric Dpthea <br /> yp . R-Detached DSFR-Attached DOupiex DMultt-Farnit -#of Uni s: <br /> T .e of Project: INNew ❑Addition ❑Remodel ( ------• C7Cotnmsrcial ❑Industrial <br /> DESCRIPTION OF WORK: DIR vai OT.I. ❑Si+n DSarjrikler ODemolition DC#ange of Use <br /> ASSOCIATED BUILDING PERMIT#(f applicable): <br /> MECHANICAL. PERMIT APPLICATION <br /> Type of Project: _New Addn PLUMBING'PERMIT':APPLICATION <br /> Alteration Repair <br /> #of #of Type of Project: New Addn Alteration Repair <br /> Efxtoras ~—_.fit ctf_Flxttxre __— list of FixturBs—_ #of <br /> FiMN Xiuias --Fixtures <br /> iaJsof-41st #of <br /> A/C-Air Handling Units 61st-cif Fixtures-..__-- <br /> I Neat Pump Fixtures <br /> MB Forced Air S sterns Toilet <br /> Backflow Preventer Inside Bldg) <br /> allill Unit Heater Bathtub <br /> Gas Piping Mil Boller Urinal <br /> �j'�� I aoate (Wash Basin) Drinking Fountain <br /> MN Gas Fireplace ]Refrl_erattan Shower <br /> Wood Straus Floor Drain <br /> Gas Rants Kitchen Sink&Disposal Grease Trap <br /> MIMI Clothes Dryer Hookups Ducting Dishwasher <br /> �Other; Clothes Washer df Gamins <br /> MI <br /> Ranoe <br /> Hood OtheMedical Gas <br /> �� Water Heater Other: <br /> Sink(Service/Bar/Moaeto.) Other: <br /> IMIMMIIIMIMIIIOIIIIIIIIIIIIIIM <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> MIChemical or Water <br /> No.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 o/a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in carting 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!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> ` City of Everett Official Use Only <br /> t% L? 7 PERt)A1 ^ <br /> Ow,or/Authorized Age Signature tu,, j BVI f 1l �(j�� ��--� <br /> 9 Signature <br /> Date <br /> (ReviSed 9123/2016) <br />