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BUILDING 1 MECHANICAL!PLUMBING I SIGN /N <br /> 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 )(E)evereftepsai7everettwa;gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) <br /> ��PR�t +1trGT`:SI 'E INFORMATION <br /> PROJECT SITE ADDRESS: (p 3 e„{ �VtC.JI�+� '” <br /> LEGAL for new construction: Short Plat/subdivisionPROPERTY TAX#: <br /> Lok No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME; 'c cidna el TeLc&rc TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET .►`'f. I t n�i+\ `�;yo('1.� <br /> / <br /> CITY tJ ex.e*l �) STATE Ui A- zip q g20 1 <br /> OWNER PHONE: 42 5 „7qt . 0 550 TOWNER EMAIL: <br /> CONTRACTOR NAME: Uri 1 1- eillin& <br /> CONTRACTOR ADDRESS: STREET 146 Y-6a <br /> er eA)Cg '� liL) STATE WA - 20 <br /> ZIP <br /> CONTRACTOR PHONE:Lt 5 asci OS 'CONTRACTOR EMAIL de4QAdie.. f <br /> CONTRACTOR LICENSE#(REQUIRED): C -I Into. S-7-i jri 'CITY_OF EVERETT BUSINESS LICENSE It REQUIRED): 1(,30(8 <br /> PRIMARY CONTACT: 0 OWNER )CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME/ CONTACT PHONE: ', Fl asci <br /> *7Q' CONTACT EMAIL: deb blC. 9c1 e*n - •toM <br /> Existing Use of Building: Contract Price of Work:$ 92.00.0O <br /> - <br /> Proposed Use of Building: Heat Source: ❑Gas , Ftectric ❑Other <br /> Building Type: XSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑industrial <br /> Type_of Project: ❑New ❑Addition ❑Remodel ❑Repair DTI, OSign OSprinkler ❑Demolition °Change of Use <br /> DESCRIPTION OF WORK; 1t in5-_aa1 duG f'SS r aa* <br /> FU { <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PgRivirr APPLiCATIQN PLUMBING PERMIT APPLICATION <br /> Type.of Project: .,New Addn Alteration Repair Type of Project: _New Addn Alteration Repair <br /> #of List of Fixtures #of #of <br /> Fixtures Fixtures List of Fixtures List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures <br /> NC—Air Handling Units I Heat Pump Toilet Backflow Preventer(inside Bldg) <br /> Forced Air Systems `Unit Heater Bathtub <br /> Gas Piping Boiler Urinal <br /> Lavatory(Wash Basin) Drinking Fountain. <br /> Water Heater Refrigeration Shower <br /> Gas Fireplace Floor Drain <br /> Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher <br /> Clothes Dryer Hookups Other: Clothes Washer Medical <br /> Medi Qiaains <br /> Range Hood cal Gas <br /> Exhaust Fan Water Heater Other: <br /> Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> !Chemical or Water I INo.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 lace/law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Huilding Official before being authorized under any circumstance.I em 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 with the Stale Contractors Law 18.27RCW and 296.200A WA C. <br /> City of Everett Official Use Only <br /> PER T <br /> [d 25.17 t. o - o 3 <br /> "owns/Au �0040 'thorized Agar/43(1111)26 <br /> igriaDate <br /> (Revised 9/2312010 <br />