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O <br /> BUILDINA / MECHANICALS PO4-fr ' ILUMBING CSIGI N/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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 0‘ .A7 I 11. k A 1 tie_ S E PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION 1 <br /> OWNER NAME: TENANT NAME(If Commercial):S l l J e r l k.ke... 0 r-I--k o doK•1-ic S <br /> OWNER MAILING ADDRESS: STREET ,,1 dB AJ p'.C;f IG S k- CAA Ak trDO 3 <br /> CITY 5 eon,}k 1 e_- STATE Lf A ZIP of g( 6 <br /> OWNER PHONE: 66 - Dod-S a(S OWNER EMAIL: <br /> CONTRACTOR NAME: 5/h0_( k true w1 p to W1 b 1 in A t vk t ek 1-1 110) 11A <br /> CONTRACTOR ADDRESS: STREET 73 5 , S p4 k Rook(�j (�et <br /> CITY 8 e 't 1 h kk`VIA i W !` DDO D D 6 STATE ♦�A ZIP 9 8 D D 6a <br /> CONTRACTOR PHONE: 360 – 731 e`��7 CONTRACTOR EMAIL: ftAFoG s pec-4-fv1/4IMpAnd QYN <br /> CONTRACTOR LICENSE#(REQUIRED): S P (=LT p {i gG J c E CITY OF EVERETT BUSINESS LICENSE#(REQUI D):_ Q``�;a D <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR f71 OTHER(Please Specify) P('0;t-C'c MO\livo q e r �(��'�—�J <br /> CONTACT NAME: CONTACT PHONE: C g i g,_ 7'-1.1- ,_ l47 s rte/ <br /> • <br /> ba>nte• i l�ek\\� CONTACT EMAIL: bp`.VUe4 ((Pc 0.`lto,„ l►, <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel El Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> "1-- 10-etiC ;z›.9.--, oi>_1,241A-0 P=ASOL-f -o314 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): l.iL.4"" <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 /> ATG.=-Air Handling Units Heat Pump 1 Toilet r Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler g 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 S Medical Gas <br /> Range Hood / Water Heater rj Other: go,c <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <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.I am the owner,or I am authorized by the owner of this properly to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18,27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> --- PE <br /> / /I1/1 <br /> q �t�r— <br /> •, ner/• •• -• A•ent Signature Date (Revised /23/2016) <br />