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PERMIT IT APPUICATI= <br /> ..UILDING I MECHANICAL/ PLUM If:NG /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 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or lack lank Only Please) lP OJECT SITE Ii` FQE MATION f <br /> PROJECT SITE ADDRESS: 1•470 SW VV(f , VI A,I( VV / PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> 1 CONTACT II FORMATI <br /> OWNER NAME: 14 jSVlnki1 Cc -1 l� '1'�1S;' TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: ll OWNER EMAIL: <br /> CONTRACTOR NAME: C)TI A)tilgio)`t tvt <br /> CONTRACTOR ADDRESS: / STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED):C f PT t-q 55 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):Q3 -961 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: O� CONTACT PHONE: q2 3'iL5 n ?-- <br /> , CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ a0 <br /> ti.,130 <br /> Proposed Use of Building: Heat Source: El Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family#of Units: ❑Commercial 0 Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.1. El Sign ❑Sprinkler ❑Demolition El Change of Use <br /> DESCRIPTION OF WORK:', e, 4-014 `- o *ICS <br /> ASSOCIATED BUILDING PERMIT#(if applicable): jt700-3 7 <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 #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures . Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump ( Toilet ( Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler I Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove r Kitchen Sink&Disposal Grease Trap <br /> 1 Gas Range Ducting Dishwasher Roof Drains <br /> I Clothes Dryer Hookups Other: Clothes Washer I Medical Gas <br /> Range Hood 1 Water Heater 4 Other: 405e <br /> I Exhaust Fan Sink(Service/Bar/Moplett.): Other: <br /> i <br /> SPRINKLE- /SUPPRESSIQ k' SYSTEM 1 <br /> Chemical or Wafer 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 properly 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 /> /� to _2_ �, PERNf9x0D <br /> / 0I DOvOwner/A oorr ed Agent Signature Date (Revise <br /> / <br />