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PERMIT APPLICATION <br /> ��■ <br /> , BUILDIN CHANICAL/PLUMBING /SIGN / I! INKLER/DEMOLITION <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@everettwa.gov I www.everettwa.govlpermits <br /> (BIM. or Black Ink Ot Please)` PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 142,: , i'. PROPERTY TAX#: <br /> LEGAL for new construction: Short Platisubdiy skin Lot No, (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME. I ' e 0 , <br /> » ; 1.4C-TENANT NAME(1f'Comrtorai � �,.G <br /> OWNER MAILING ADDRESS: SReerriiit '74tQ 71f7 ST 3e <br /> cmr C)p Qf <br /> L� STATE if ZIP 82_ le <br /> OWNER PHONE: 32 2Ceo 2, +,�� OWNER EMAIL: <br /> CONTRACTOR•NAME si"m A. <br /> CONTRACTOR ADDRESS: STREET Ill Pjliq 6 alitt)a...,t1., <br /> T STATE <br /> ziP ,- <br /> CONTRACTOR PHONE: Lf ReSg SCONTRACTOR EMAIL <br /> CONTRACTOR LICENSE#(REQUIRED): r. d <br /> Vi CITY OF EVERETT BUSINESS LICENSE. ELI>«II�E�� � 6* <br /> PRIMARY CONTACT: El OWNER OI 1TI2 t 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE <br /> CONTACT EMAIL: : , P' coij- c4— e(br <br /> BUILDING PERMIT APPLICATION <br /> l xistin• Use of Butldin•; Contract Price of Work:.$ t o 00 <br /> Pry•orad Use of Blildin±;: Heat Source <br /> Gts ❑Electric ❑Other <br /> Buildin• T;•a. ❑SFR-Detached ❑SFR-Attached ❑Duotex 01k/tulti-Farna`4 of Units: ommercial ❑Industrial <br /> Tjfpe;of Project ❑New DAddition ❑Remodel st mt DTA. ❑S)gn E Sprinkler DDemolition OChartge of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT# tf.applicable): <br /> MECHANICAL'PERMIT APPLICATIONPLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn Alteration,Repair Type of Project: New _Addn Alteration Repair <br /> #of _. . <br /> List of Fixtures #of #of <br /> FixturesFixtures Fixtures List of Fixtures List of Fixtures #of I <br /> Fixtures <br /> List of Fixtures <br /> NC–Air Handling Units Heat Pump Toilet _ txr <br /> Unit Heater a t� ( <br /> w Preventer Insldo,8l Bldg) <br /> Forced Air Systems ;:..., <br /> Ba <br /> GGas Piping Boiler` ' <br /> as r Heater Lavato (Wash Basin) IDrinki•$ Fountain <br /> Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove <br /> Kitchen Sink. spa} Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer HookupsOther: <br /> i Clothes Washer luled'ical Gas <br /> Range Hood Water Heater w <br /> 1Exhaust Fan � `sink <br /> Other: <br /> r t(S loe B itl tie pt td) Other <br /> SPRINKLER/SUPPR SSION SYSTEM <br /> jNumber 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 /> :went 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 /> 3uilding Oficial 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 /> ind I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City ofEverett e tOfficial Use <br /> Only. <br /> PERM T <br /> tf . [ -- 0 <br /> )" =ttA►ithotlar.ed Agent Signature Date <br /> d vlseoV2 2014) <br />