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IIIIII PERMIT APPLICATIO-L <br /> eitAi:°::/" Alli"-- BUILD! MECHANICAL MECHANICAL/ PLUMBING /SIGN/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 INFO ATION <br /> PROJECT SITE ADDRESS: 2 y / F (ot'JI <br /> �J "Ll CQi�v�® � (1l ' PROPERTYTAX#: A � �tO l 7�( <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) �711b <br /> � <br /> CONTACTi / INFORMATION <br /> OWNER NAME: `ikeil t3 - 6Ita�t �Q,l Wt( TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET oo(,n®�/� (/ L ' ,.,10 ieigyd <br /> CITY ) Iii-re44„, STATE WI ZIP V 20ej <br /> OWNER PHONE: `/1Z 29' "/22.3 OWNER EMAIL: 61140e. WAlterflgreiti.Coe-3 <br /> CONTRACTOR NAME: 7/44 A/ j11400,'C()� �,g.4-•/ . <br /> CONTRACTOR ADDRESS: STREET 1859 eor /4„,,. 6 <br /> STATE % ZIP fol?7 <br /> CITY / {{" <br /> CONTRACTOR PHONE: 1'/74'. 74 y7 )-7 , r7 CONTRACTOR EMAIL: 2/) <br /> CONTRACTOR LICENSE#(REQUIRED): Mfr/l/UN/V1,v�/ 06O a° CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 034 J0 <br /> © <br /> PRIMARY CONTACT: 0 OWNER L? CONTRACTOR 0 OTHER(Please Specify) r7 <br /> CONTACT NAME: CONTACT PHONE: Ll Z•5- 7 <br /> - 5 7-, 7j_7 <br /> f/l rniz._ CONTACT EMAIL: Otei be*Ca an piled?.Cowl <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Wi rk:$ • <br /> Proposed Use of Building: Heat Source: ❑Gas i -ctric •• -- <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex 0Multi-Family4 of Units: ❑Commercial 0 Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign El Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <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 _Adds _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 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 Sink(Service/Bar/Mop/etc.) Other: <br /> 3 API3P oar-4,14 <br /> SPRINKLER I,SUPPRESSION SYSTEM R (%(per) <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 property to perform the work for which application is made, <br /> and I comply with the State Con., tors Law 18.27 RCW and •..-200A WAC. <br /> City of Everett Official Use Only <br /> ‘79/(7--- PTik4OS —(7)‘• <br /> Owner/Authorized Agen ignature Date (Revised 9/23/2016) <br />