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• <br /> PERMIT APPLICATION <br /> grrBUDDING!ME HANICAL 1 PLUMBING I SIGN/SPRINKLER I DE OLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)423-257.8810 I FAX 425-257-9857 I(E)everetteps@evoreltwa.gov( www,everettwa,goy/,emits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMA'T'ION <br /> PROJECT SITE ADDRESS: .0 4V . E iNe, 6- W-.15 PROPERTY TAX#; C! <br /> LEGAL for new construction: Snort Plat/subdivision Lot No. (attach copy Of long legal description). <br /> • <br /> CONTACT INFORMATION • <br /> OWNER NAME: 1 f i D} .1au TENANT NAME If Commercial}: <br /> OWNER MAILING ADDRESS: srat:er 1♦ 40 f <br /> GIT. x .11 . I STATE W ii ,- i: <br /> I ,: <br /> OWNER PHONE: 'i 1 ,i OWNER EMAIL;CONTRACTOR NAMVl.lE; hT R 1 G( i b, J 1i-- "L 4A-T&R- 11 <br /> 11=1.11 <br /> CONTRACTOR ADDRESS: s'rRECT LJ ftp,I [Z.— I( k C '6 i UX 721 ' <br /> CI'n l..r 0- l STA7e thib 0 4 <br /> CONTRACTOR PHONE; 26 40- 's. CONTRACTOR EMAIL: 4, 'kg 'a,■'V'6 1411-i (CM <br /> CONTRACTOR LICENSE#(REQUIRED): W* L 36•) ' ciTy OF EVERETT BUSINESS LICENSE#(REQ;MED): a ? g <br /> PRIMARY CONTACT: a OWNER R CONTRACTOR a OTHER(Please Specify) IIIII <br /> CONTACT NAME:, <br /> AM CONTACT PHONE: 9.3- a 7`c` rA / L /s <br /> CONTACT EMAIL: r'. <br /> ILDINO PERMIT APPLICATION <br /> Exiskin! Use of Buiidin.; :f / , Ilin! / Contract Price of Work:$ ElfiliiMIMMINIIIIIMI <br /> Pro•oged Use of Building: Heat Source: IJGasgrctric bother _ <br /> Building Ty e: DSFR-Detached DSFR.Attached 1041, plex DMultl-Family-#of Units: <br /> lTlComm-r i=1 ' ©Industr'� <br /> T •e of Pro ect: ONew DAddition DRemodel D-epair DT.I. DSi•n ( Sprinkler ❑Demolition ❑Change of Use (7111= <br /> . <br /> DESCRIPTION OF WORK: � <br /> GIA4. VIA6.4._ %.1--.1eiCifite-- i Lake/W.2) MI id-6r NH/ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL. PERMIT APPLICATION <br /> Type of Project New Addn �Altaratlon _Repair Typo of Project: _N <br /> #of New _Addn ,AUteratio, _Repair <br /> List f Fixtures #of #of List of Fixtures <br /> oFixtures Fixtures ListofJJXtures #of <br /> Fixtures f=ixtures �!of Fixtures <br /> NC-Air Handling Units Heat Pump Toilet <br /> MUM Forced Air Systems Unit Heater Backf venter(inside Bldg) <br /> Gas Piping•'• BakhtubIMMIIIMMIIMIMIMIIMII <br /> .� Boiler Leveto (Wash basin) MN Drinkin. Fa <br /> Water Heater Refrigeration Shower <br /> Floor Drain I • <br /> Gas Fireplace Wood Slave Kitchen Sink&Die*osai MUM Creast'Trap <br /> Gas Range <br /> Ducting Dishwasher 1.111111 Roof Drains <br /> Clothes Dr er Hookups Other: Clothes Washer <br /> Ranke Hood MIOther: E Gas <br /> Exhaust Fan_ Water Heater Other: <br /> —�� Sink(Service/t3ar/Map/etc.) Other: <br /> • SPRINKLER/SUPPRESSION SYSTEM • <br /> _ Number of HeadsMOM <br /> W <br /> ACKNOWLEDGEMENT I have reviswad IMe application and confirm the information contained herein is flue and correct.Work done pursuant to this pe 'it must comply with <br /> current federal,state,and local few.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be aothoriz;,In writing from the <br /> Building Official before being authorized under any clricumstanco.l em the owner,orf am authorized by the owner of this property tip perform the work for loft application is made, <br /> and 1 comply with the <br /> Slate Contractors Law 18.27 P.CWand 206,200A WAC. ' <br /> Ll i iii <br /> City of Everett Official se Only <br /> 5-(os,- PER IT# . <br /> NW <br /> bel <br /> O `1Autl3orized Agent Signature4,mituit, <br /> -11 , <br /> Date (Revised Mr '.016) <br />