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PERMIT.-,•ii BUILDIMMIECHANICAL I PLUMBING /SIGN` RINKLER/ DEMOLITION <br /> 401111 ,24- CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 I(E)everetteps@everettwa.gov j vww.everettwa.gov/perits <br /> Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 624 11'Z,, ..r . PROPERTY TAX#: 2.843 s7 I0302 <br /> LEGAL for new construction: Short Plat/subdivision <br /> Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: jG U b6 Lerr4 Vju ,LLZENANT NAME(If Commercial): <br /> Alopel— /104,1e— <br /> OWNER MAILING ADDRESS: svteei J7��42.6,��y�se �2:-/X71.1 sr cut IF � y <br /> any l r6G F�.1�.�... I J lig-TTS 4J STATE jj f 1!� ZIP / {Be}'7'C 7 <br /> OWNER PHONE: /2.c 944 I _ g 412_2- ,OWNER EMAIL: 1'uLI E gDPAr tri Pt- rr <br /> CONTRACTOR NAME: kik, .1 tie' SI 1Z_Vc.1-1) P-E I,. L. C., 1 <br /> CONTRACTOR ADDRESS: sTREEr 7412(f 271."4SI-a SuITG <br /> 215 <br /> cm' AAM., 11- {-51-4 STATE '.. ! ZIP 960 / ' <br /> CONTRACTOR PHONE: 442s-- 281-( CONTRACTOR EMAIL: T� <br /> ,,,.,1•e.0 44 <br /> CONTRACTOR LICENSE#(REQUIRED): f,/)j/J/g� 8E o f <br /> ES <br /> `� CITY OF EVERETT BU S LI ENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER iiirCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: ,� CONTACT PHONE: c 2 C"L 4 t�r. 66 i <br /> c ? <br /> r k1J v“?... CONTACT EMAIL: J it <br /> p <br /> BUILDING PERMIT APPLICATION 1 <br /> Existing Use of Building: Contract Price of Work:$ 4 ro0c) <br /> Proposed Use of Building: Ct4(,LP® (2--7-- Heat Source: ❑Gas ❑Electric ❑ <br /> Other - <br /> Building Type: ❑SFR-Detached DSFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑industrial <br /> Type of Project: ew ❑Addition ❑Remodel ❑Repair On ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION O WORK: <br /> /N ST'A-Ge_tr t orJ or- Pt wm i i )0 M cilhepaer o t}rz NOLO <br /> Mort)uPrc c')Kew 4-1o,vt.0"_ (12 X ‘:>2.—) <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 1ddn u (ter Horta._Repan <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures} <br /> #of , of <br /> Fixtures L/st of 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 Medicall Gas <br /> Range Hood Water Heater Other: <br /> Exhaust flan Sink(Service/Sar/Mop/etc.) Other: _ <br /> SPRINKLER I SUPPRESSION SYSTEM <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 1 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 16.27 RCW and 296.200A WAG. <br /> City of Everett Official Use Only <br /> a <br /> ,e ---0 ll—/— <br /> / f PERMIT# <br /> 1 <br /> Owner/Authhoriized A ent Si nature I <br /> � 9 Date ni I - Do <br /> (Revised 9/23/2018) f <br /> Iz-- <br />