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PERMIT APPLICATI• k <br /> BUILDIN =ECHANICAL/ PLUMBING /SIG RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERV <br /> gn" <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE,INFORMATION; <br /> PROJECT SITE ADDRESS: P.r�Y �I vetPROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ?hal; <br /> CONTACT INFORMATION <br /> OWNER NAME: ?hal i Q 2:64,e TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET $"OOq 8 .e,fy 131 v /� j., <br /> CITY Ev STATE W4 ZIP 102-03 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: CAW* <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: i5,�OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: a(Q p— 1?-2.0—Oita <br /> PN 1 L L 1 P 1 s CONTACT EMAIL: 0,1,1;O ctza 6 6-1-ti10:1 t.CO <br /> BUILDING:'.PERMIT APPLICATION <br /> Existing Use of Building: 440 me Contract Price of Work:$ IST S &o <br /> Proposed Use of Building: ROrVL( Heat Source: j1'Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial CI Industrial <br /> Type of Project: El New ❑Addition ❑Remodel DRepair ❑T.I. ❑Sign ❑Sprinkler CI Demolition El Change of Use <br /> DESCRIPTION OF WORK: <br /> FI A►5K;vt_3 M&Szvn►enT . IINA&ivtc� a BecQlfw..,„% I 5+#fn reo»,\ — tat 2 slr.)kS , I -Ir=i t�-4 <br /> 0 51nou.enr <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 #°f List of Fixtures #of 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 /> 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 r Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/:SUPPRESSION SYSTEM, <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 Official before being authorized under any circumstance.I am the owner,or!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 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> P/2 e_ f&oi-f- rad <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) r'' •, <br />