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Jul 18 2018 10:52AM Washington Water liters 8663757454 page <br /> PERMIT APPLICATION <br /> BUILDING 1 MECHANICAL I PLUMBING /SIGN I SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> #111111j:‘ <br /> 320D CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8610 ( FAX 425-257-6857 i(E)everetteps@evereltwa.gov i www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please)�7PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:,3 o / 44 4 5* PROPERTY TAX#: % j,,7 /302- <br /> LEGAL.for new construction: Short Platlsubdivision Lot No, (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: kt I Iltt( 1 ,r�J ^� t`a,, r TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: eraser 3-30-7 ,:a 5f '7 <br /> CITY u- e:i+ STATE W� ZIP 9 gzo f <br /> OWNER PHONE: ( 41gt_ 6,63, OWNER EMAIL: <br /> CONTRACTOR NAME: (/i,/tfr5t41 h1 Cfnli-+ r,())41'1 L H 1476-(ej <br /> CONTRACTOR ADDRESS: STREET I/15 Z the L - Air C. 5C PO 4130X sy'o 8 <br /> r ciTY e/�cr i STATE f XIP qO .)56 <br /> CONTRACTOR PHONE: 42-6-42qg7/ pCONTRACTOR EMAIL: 61.14-1,4A-H.09-6am��L, (9n <br /> /T <br /> CONTRACTOR LICENSE#(REQUIRED): W --9-p f/`Or CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 06 3V <br /> ej <br /> PRIMARY CONTACT: ❑OWNER 4.CONTRACTOR 0 OTHER(Please Specify) <br /> CO ACT NAME• CONTACT PHONE: 2g —�f <br /> c3 '71 <br /> V f r DoJ1( Is CONTACT EMAIL: ff 1ZJ/-fii, @ 6 6.0-x„.(evil <br /> OIILDING PERMIT APPLICATION <br /> Existing Use of Building: i2e gotti4 Contract Price of Work:$ <br /> Proposed Use of• ding: Heat Source: ❑Gas I lectric ❑Other - <br /> Building Type: R-Detached DSFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial 0 Industrial <br /> Type o`Project: ❑New )]Addition ©Remodel DRepair ❑T.I. OSign ❑Sprinkler ❑Demolition ©Change of Use <br /> DESCRIPTION OF WORK: r <br /> fi i 01-' l f EleCi-V?G 1 f S <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 Repo r �-"Y? <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixture <br /> -���---"""iiii�������` <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 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: _ Niz, Clothes Washer Medical Gas <br /> Range HooWater Heater Other: <br /> Exhaust Fan •Sink(Service/BariMop/etc.) Other: <br /> SPRINKLER/SUPPRESSION 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 few.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Cfficial before being authorized under any circumstance.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 00mply with the state Contractors Law 16.2r, and 298.200A WAD. <br /> (...... ...),Erkilatet <br /> i City of Everett Official Use Only <br /> d <br /> 7.4 P1= � <br /> # , _ 0 3C <br /> 0 er/Authorized Agent Signature Date (Revised 5/20/2016) <br />