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• <br /> PERMIT APPLICATION <br /> 1:0;111,4411Wf BUILDING 1 MECHANICAL I PLUMBING/SIGN i 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 1(E)everetteps@everettwa.gov f www.everettwa.gov/permits <br /> (httae•®r black Irak®.nlg(•Please) PRQJECT S TE INFORMATION <br /> •• • •PROJECT SITE ADDRESS: 20( BaottotoofleiPROPERTY TAX#: OOY 3907/ 2L7/& <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> . ..coNt.AdT/IkVP®R➢{ ATI®N . •. . ' • .. <br /> JO <br /> OWNER NAME: 6/JO . © man Q <br /> , go m4 "1t jENANT NAME(if Commercial): <br /> OWNER 1VIAJLING ADDRESS: STREET �3ZO( 6 40A194) r► ���� ��(/�� G�Q • <br /> CITY eel/49, ( STATE tAs�••�- ZIP ['C/ <br /> OWNER PHONE: 5c oil Dtl�l1(,- OWNER EMAIL: 5ruocIro wemA ► <br /> CONTRACTOR NAME: C vA E i'J 5`ter L T: ff C67-04, -G <br /> CONTRACTOR ADDRESS: STREET 2-(°Z0 e l AU e <br /> • <br /> ITI -Gummi- STATE (,tl.,-- ZIP 614:320/ <br /> CONTRACTOR PHONE: 4 -5-2c 2..-'3((q • CONTRACTOR EMAiL: MA t,@ c_5544,10A ,ettii <br /> CONTRACTOR LICENSE#(REQUIRED): C(J9,5`IUSS X22.0 r CITY OF EVERETT BUSINESS LiCENSE#(REQUIRED): f,to el c <br /> PRIMARY CONTACT: ❑OWNER IaCONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4 7 5-2-5-2-,/l V <br /> /14144- A-7-kte_ CONTACT EMAIL: MA4_ @ gc54I.w4,eA <br /> BUILDING.PERMIT APPLICATION <br /> Existing Use of Building: of-f-ta 1 Contract Price of Work:$ 1 Z,igg. <br /> Proposed Use of Building: ( ACV" Heat Source: ❑Gas l.Electric ❑Other <br /> Building Type: ❑SFR-Detached DSFR-Attached ❑Duplex ❑Multi-Family-#of Units: in Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remode( RiRepair ❑T.I. ❑Sign ❑Sprinkler ❑Dem/Solition CiChange of Use <br /> DESCRIPTION OF WORK: Rowe <br /> io t /A-ee . (Dt-!T lJ c/5t�/141 4lc'/'fll'`- 1401MT/'U/� <br /> e <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL•PERMIT APPLiCATION • - PLi nt.oimO PERMIT APPLICATION , <br /> Type of Project: _New Addn Alteration rRepair 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 R• efrigeration 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 /> .SPrn NIXLER/S.0 PRESSION 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.lam the owner,or I 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 /> PERM �� <br /> l/z� (cod K <br /> G2sv„el/Autho ed Agent Signature Date` (Revised 5/20/2016) <br />