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PERMIT APPLICATION■ <br /> BUILDIi MECHANICAL/PLUMBING/SIGNINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 (E)everetteps@everettwa.gov( w.wl.everettwa.govlpermits <br /> ( S o 10at.#Iinl Oit.Pte*$ - , PRtt*O 'SITE iNlS l 1/k# 0t.. _r M, q <br /> PROJECT SITE ADDRESS: ej1 t PROPERTY TAX#: 00374 too ad ifieln <br /> LEGAL for new construction: Short Plat/subdivision ��ghli No (. (attach copy of long legal description) <br /> OWNER NAME: irilAthdt V) jhxib ,,,,. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 14c,2.4 tini ft. kill (4)11 t\.DS►f Apr <br /> cnY .4 STATE W ZIP i rWWWWW <br /> 0704, <br /> OWNER PHONE: 1/D-h-3(3 - 4?-9 f O OWNER EMAIL: ` <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE LP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: A1)t"'�, .577i 3?�� <br /> to Z ) CONTACT EMAIL: ��' "` Catali'" 4'9 . <br /> Existing Use of Building: ,6A. "„tttr j • Contract Price of Work:$ 000 II <br /> Proposed Use of Building: tt Heat Source: ❑Gas HElectric ['Other <br /> Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ['Industrial <br /> Type of Project: :New ❑Addition Oemodel ['Repair ❑T.I. ❑Sign ['Sprinkler ❑Demolition ['Change of Use <br /> DESCRIPTION OF WORK: <br /> 1 kCeVikIND t+R 'Co Ga'W oco GDS "bete agkel . <br /> 4t44 vticm '4 Vitt' "jo \44 Ate- ► t <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> _MECHANIC cL PERMIT APPUC.A'1ION. �; PLUMB INGFPEi`i;MIT APP .IGA11ON <br /> Type of Project: _New _ Addn Alteration _Repair Type of Project: _New Addn Alteration _Repair <br /> #of #of List of Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—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 Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan t aX 3i Sink(Service/Bar/Mop/etc.) Other. <br /> .. PRINKLER SUPPRE Sto**** EM 2, <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.lam the owner,or)am authorized by the owner of this property to perform the work for which application is made. <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 0#40H.„ PERMI <br /> o 60 \ <br /> Own= •ut n Signature Data (Revised /23/2016) <br />