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477PERMIT APPLICATI <br /> BUILDING /MECHANICAL/PLUMBING/SIGRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES :Irj rr . <br /> 3200 CEDAR STREET,EVERETT,WA 98201 1=`A -ANAL <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> " r " ;,"'wel t _ * FSP*OJECT SITcNFOR ATIOMia i"qorkww ..,, :r <br /> PROJECT SITE ADDRESS: ,..s--00 c L)\ or L 3 ROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> � I� �IIG�����°� __ �eH� 9 v �. i i a i 'Fi pr i i t i ''lyi �" +9q�kr8 9 �i <br /> '$,104,I PO "ia ��W:-.,, 4U � I��''. [r ,gCON,TAC1 INFO M O0il i !11 U _ 5tii I �� r 6 s =,l <br /> OWNER NAM�a V\2 22 Y/ TENANT NAME(If Commercial): <br /> OWNER MAILING A RESS: ' STREETvj q�2– l (J V ( \) J /l <br /> CITY Fr''C/1" e/tt STATE V—) A. ZIP (4 1-(') <br /> PHONE: -- ----q01-7 OWNER EMAIL: IR,Loi <br /> i <br /> CONTRACTOR NAME: 1 A t --f' f� <br /> CONTRACTOR ADDRESS: STREET 7 ( L Le 2zb s rV i (,"' ---7 !� <br /> CITY /i STATE l"../ � /yA ZIP �1 - 1 <br /> CONTRACTOR PHONE:4+ ``I ��- —7 ( ?j I CONTRACTOR EMAIL: VI I, -i <br /> CONTRACTOR LICENSE#(REQUIRED):RLI CFP AU / `4 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 2--1'-1- . <br /> m . Q ,dr4.. �..��, — .tea, .' <br /> PRIMARY CONTACT: 0 OWNER %CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:0--1A-o _ CONTACT PHONE:t f')/ J -- \ •no C <br /> Qrj�j( i 7 (�1 <br /> Am lo/ CONTACT EMAIL: lr\ ((G\ <br /> ,' s1—MiLih„;;. ,_ ._ BU0DING P,ER JT PPLIGATIONr, , , M.,x - = > . <br /> , <br /> r <br /> Existing Use of Building: Contract Price of W :$ . lA <br /> Proposed Use of Building: Heat Source: [(Gas ❑Ele ' er <br /> Building Type: • FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project( DNew ❑Addition ❑Remodel pair OT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): • <br /> xMECHANICAL,PERMIT,APPLIC/ATION. A. ,tl_ PLUMBI,NGG:,PERMIT APPLICATION t <br /> Type of Project: _New _ Addn Alteration _Repair Type of Project: _New Addn Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> i Forced Air Systems Unit Heater Bathtub Urinal <br /> t Gas Piping Boiler Lavatory(Wash Basin) I 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 Sink(Service/Bar/Mop/etc.) Other: <br /> -; nSPRINKLER'I SUPPRESStON,SYSTEMr 'u <br /> Number 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 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 /> and I comply with the State Contractors Law 18.27 RCWand 296.200A WAC. <br /> City of Everett Official Use Only <br /> 0 OP 0 / ' I ( PERMIT# <br /> • �113-7/1V6G2 A hn. 4 (:) 2 -- cdo t--A <br /> Owner/Authorized A.• iiipr <br /> iii Date (Revised 10/12/2015) <br />