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III PERMIT APPLICATIO I I <br /> "IlliA/4:74---A <br /> BUILDIN!7�MECHANICAL/ PLUMBING /SIGWAN PRINKLER/ DEMOLITION <br /> vitil <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT, 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: I 3( 14' PL W PROPERTY TAX#: 170Ctf/3 C? X 27 <br /> LEGAL for new construction: Short Plat/subdivision relle4461.tr t",r4 Lot No. -7 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TAP?- 22/ AB, ( / TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET r /ct73( 1 erg- ,pe._ 43 <br /> CITY V b 0 _ STATE bt.4- ZIP elgocet- <br /> OWNER PHONE: '7 O Q 2*7 'Z',P OWNER EMAIL: <br /> CONTRACTOR NAME: __, ` &, b - f 1 dl Y_J r\le_fie___-/ <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: .r — 76/_ AO7 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 <br /> ,OWNER 0 CONTRACTOR I OTHER(Please Specify) 0/43A- f5 i4 ale <br /> T, <br /> CONTACT NAME: ►Y,,rr P A.. „-cit CONTACT PHONE: 4- -.- 3 46- ZS-3 GS <br /> CONTACT EMAIL: bPA-Lw!4f=pf l ��AQL r CpQyj <br /> /�` BUILDING'PERMIT APPLICATION <br /> Existing Use of Building: JT 'c- Contract Price of Work:$ S " <br /> Proposed Use of Building: 6 Heat Source: ❑Gas $ lectric DOther <br /> Building Type: KSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New KAddition2emodel El Repair ❑T.I. ❑Sign El Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: /_D� 1 D -t 0Z F -a— 0 � Re-4e_ 7F 6`t67(166-- 1 - ,77/ <br /> 4 ei vm' H>6 'r t�- '7�- - eel i a7 <br /> 1393 . 38 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn X Alteration _Repair Type of Project: New IS Addn X 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 1 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> 1 Gas Piping Boiler Z Lavatory(Wash Basin) Drinking Fountain <br /> I Water Heater Refrigeration I 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 /> I Range Hood Water Heater Other: <br /> I 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,sta-,and local law.T : : -nting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official;- .re being authori -d un.. any circumstance.I am the owner,orI am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply e State Contra.ors Law 8.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ' 40PV I /t fA ze� PERMIT#0)n 05-60. <br /> Owner Authorized Agent Si•nature Dat (Revised 9/23/2016) <br /> (../...12.-- <br />