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II UII <br /> ,rte BUILDIA J MECHANICAPERMIT APPLICATIOL/ PLUMBING /SIGN 15PRINKLER/ 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: l/W? /9 AQP Se- r J , ' PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: slu ne_yyl ly) Alem TENANT NAME(If Commercial): .5 I Uej-k Fes" Cf l h f li <br /> OWNER MAILING ADDRESS: STREET 1/ii-/y / g 4vi �e- <br /> CITY EV� '(1 STATE 44 A ZIP64;2E <br /> OWNER PHONE: �3- ?5 est 1 OWNER EMAIL: GA hern <br /> npYI`Q �^�,,(L.c ow) <br /> CONTRACTOR NAME: NLk/ C eel 5R1-Vt.c.-;J C <br /> N , ' l <br /> CONTRACTOR ADDRESS: STREET Gf4 <br /> 9 117 13g l 0-- 5( " / / <br /> CITY L�VI I/1 WiP1 l STATE h✓/k ZIP 01E? <br /> CONTRACTOR PHONE: (:? - Q/U - //� r t IC'1ONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED):�`'' '� ` C�� OF EVERETT BUSINESS LICENSE#(REQUI--' : j O ? <br /> lbw r0 �D <br /> PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR I OTHER(Please Specify) Al ( '5GKG- <br /> CONTACT NAME: / <br /> CONTACT PHONE: �� , C�(�"�r. O f r� <br /> �I'Q X 5k-tOft CONTACT EMAIL: ill'Net It1,` ��� <br /> � y1 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: �� -�7a,ODD.o2 <br /> Proposed Use of Building: ,feJ fh (/77((_- Heat Source: ❑Gas L3Electric ❑Other <br /> Building Type: ❑SFR-Detached/ ❑SFR-Attached ❑Duplex Multi-Family-It of Units: Commercial ndustrial _ <br /> Type of Project: ❑New L ,Kddition ❑Remodel ❑Repair LV,i I.• ❑Sign ❑Sprinkler ❑Demolition UChange of Use <br /> DESCRIPTION OF WORK: <br /> *-p AA acupociwe, ch1 C_ 6v-trtk I,140 04 <br /> ,. „ ,.--., . w - - i i' - 5e-ted' u,.:l�G <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 pair <br /> #of List of Fixtures #°f List of Fi #°f List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units He- - mp Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems I nit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Ba Drinking Fountain <br /> Water Heater Refrigeration Shower - Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Si, &Disposal Grease Trap <br /> Gas Range Ducting Dishw,. er Roof Drains <br /> Clothes D - Hookups Other: Cl. es Washer Medical Gas <br /> Range .od I ater Heater Other: <br /> Exh-.st 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 lam 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 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> _.......%11111, 5- 20 PE' \gb -- O2G, <br /> i. ner/Authori' Agent Signature Date (Revised 9/23/2016) <br />