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PERMIT APPLICATI a <br /> BUILDI�MECHANICAL/PLUMBING/SIG III .RINKLER/ DEMOLITION <br /> vii . '�_ CITY OF EVERETT PERMIT SERVICES <br /> - 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE.INFORMATION <br /> PROJECT SITE ADDRESS: $110 g4m. I /€ W bbn{I.PINId- A PROPERTY TAX#: <br /> LEGAL for new construction: ,Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 511-ham 'CCFS(►.Ik'f>uot Lit— TENANT NAME(If Commercial): <br /> . OWNER MAILING ADDRESS: STREET 11;70 LA aDtdfr y{L&h OQ„ Sqg al <br /> CITY SAKI m G STATE GdiCk, ZIP aso 2...2., <br /> OWNER PHONE: (jti.,0 ?>447-*0T/ OWNER EMAIL:INIAMS&P <br /> j7_/ ;` ,Oi v <br /> CONTRACTOR NAME: CMP 4 t 1 MC1N <br /> CONTRACTOR ADDRESS: STREET t,r7 !sr Pt. SW <br /> cm, VINN win 0 STATE IAik ZIP 41617 <br /> CONTRACTOR PHONE: (470V1 - 1.1 CONTRACTOR EMAIL: Q 11�/y _ I .�,l <br /> CONTRACTOR LICENSE#(REQUIRED): Q(�.� "rft � CITY OF EVERETT BUSINESS LICENSE#_(REQUIRED):ocsttrde, <br /> PRIMARY CONTACT: 0 OWNER IPICONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (oi) U51. tell <br /> tow poim CONTACT EMAIL: C t5 Opv101a ,` <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ IDIN&L, <br /> Proposed Use of Building: Heat Source: @Gas INElectric El Other <br /> Building Type: DSFR-Detached DSFR-Attached @Duplex ;Multi-Family-#of Units: El Commercial El Industrial <br /> Type of Project: @New DAddition @Remodel 5tRepair CIT.!. @Sign DSprinkler ❑Demolition El Change of Use <br /> DESCRIPTION OF WORK: Te r 4/100%1 tik ( r�( O#t� dO s"46,- %le <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <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 /> A/C-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 Sink(Service/Bar/Mop/etc.) - Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I No.of Heads <br /> ACKNOWLEDGEMENT:l 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.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 /> PERMIT# <br /> 61%1111 3 (-703-035 <br /> Owner/Authoriz d Agent Signature Date (Revised 9/23/2016) ( ,,, <br />