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PERMIT APPLICATIC=,,, <br /> E:IDILDINNH' MECHANICAL/ PLUM I ,ING /SIO RINKLE- / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> �N .. . 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 /> (Blase or r_lack Ink Only Please) PROJECT SITE INFO :M kTION <br /> PROJECT SITE ADDRESS: j f eo r- L) (Q S N )" 0) PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision 5 Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (7,-y,«,el- $1114 c —f TENANT NAME(If Commercial): 2 d t/'5 Ty-kc e k e Ck_ <br /> OWNER MAILING ADDRESS: STREET 1 <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: c,,,.:•Q ,1. s' C,-,)?)9 <br /> CONTRACTOR ADDRESS: STREET pppg341 r ) S ..,L 4�j, i / <br /> CITY ) l// 4./ STATE IAA, ZIP • �'-{ <br /> / / .',/ <br /> CONTRACTOR PHONE: 6� � � f� CONTRACTOR EMAIL: ra n Se)u y, )s, c <br /> CONTRACTOR LICENSE#(REQUIRED): j e CITY OF EVERETT BUSINESS LICENSE#(REQUIR D): r ' \ <br /> ��-/rTS _ x51 �l � <br /> PRIMARY CONTACT: 0 OWNER L CONTRACTOR 0 OTHER(Please Specify) <br /> ` / jCONTACT NAME: ,/ CONTACT PHONE: <br /> 1 ( CONTACT EMAIL: r 4 n G•. < p) o "y,-1 7c,/ 0 , <br /> BUILDING PERMIT APPLICATION 1 <br /> q. 0 <br /> Existing Use of Building: Contract Price of Work:$ 2 b®C1 <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric DOther <br /> Building Type: DSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: DCommercial Dlndustrial <br /> Type of Project: Iew DAddition DRemodel DRepair ❑T.I. ❑Sign DSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF QVORK: <br /> /0e ( 366 Pre____.Vs'Ae- i-7-- �- GZ.0o(-) <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 #°{ 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 /> SP LER/SUPPRESSION SYSTEM <br /> Chemical or Water I e 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 Contractors Law 1 7 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> f ! 2- ; r/� r< t 6® � <br /> Owner/Authorized Agent§ig' natu Date (Revised 9/23/2016) <br />