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PERMIT APPLICATION <br /> BUILDING 1 MECHANICAL/PLUMBING I SIGN /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:)everetteps@everettwa.gov I www.everettwa.govipermits <br /> (Blue or Black Ink Orli Please) PROJEGTBITE,INFORMATION <br /> PROJECT SITEADDRESS: `7025 6 PROPERTY TAX#: <br /> LEGAL for new construction: Short Platisubdivision Lot No. (attach copy of tong legal description) <br /> CONTACT iNPDRA`rIoiti <br /> OWNER NAME: Clna.13 SFS ft.....e* TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP.. <br /> OWNER PHONE: 2 29b OWNER EMAIL: <br /> CONTRACTOR NAME t ��Irl a <br /> CONTRACTOR ADDRESS: STREET <br /> .. CrrY eioCzeit - STATE\A ZIP ?2_0 .a <br /> CONTRACTOR PHONE:435 p,,5905V0 CONTRACTOR EMAIL: deetici)ep i �P1.e�B C <br /> CONTRACTOR LICENSE#(t Et UIRED):Cret r ita r ,e 1'td n c4tY OF EVERETT BUSINESS_LICENSE#(REQUIRED): t croqs <br /> PRIMARY CONTACT: 0 OWNER rid CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (-,I " 59 <br /> CONTACT EMAIL: C 3 TI �',(yl y„t cA its 'to i <br /> Existing Use of Building; Contract Price of Work:$ me 00.01 <br /> Proposed Use of Building; Heat Source: , s ❑Electric (Other <br /> Building.Type: SFR-Detached ❑SFR-Attached DDup)ex ❑Multi»Fanily#ofUnits: ❑Gommerolal ❑lodustrial <br /> Typa of Prole New ❑Addition ❑Remodel CIRepair ❑T.t. CtSign CIS flakier ❑Demolition °Change of Use <br /> DESCRIPTION`OPWORK: Ii��J II l#Iess L 4. kwl <br /> ASSOCIATED BUILDING PERMIT#(if;applicable);; <br /> MECHANICAL PERMIT'APPLICATION TION PLUMBING PERMIT APPLCATION <br /> Type of Project: New Addn _Alteration _Repair 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 /> A1C-Air Handling Units Heat Pump r Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems UnitHeater 'Bathtub Urinal <br /> ' Gas Piping Boiler " 'Lavatory(Wash Basin) Drinking Fountain <br /> I Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace r <br /> P Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range 9 Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes WasherMedical Gas <br /> RangeWater Heater Other: <br /> -Hood <br /> Exhaust Fan <br /> Sink(Service/Bar/Mop/etc.)... Other: <br /> . <br /> PRIN LER/SUPPRESSION SYSTEM <br /> i Y <br /> Chemical or Water 1 INo.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application end confirm the Information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federal,slate.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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 9'Co > 1 I PER # I vc)1 0 5 <br /> One/Authorized Agen ignature Date (Revised 9l23f2Ole! <br />