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- PERMIT APPLICATlO� <br /> _, : . � <br /> BUi'LDIf�1ECHi4NICAL/PLUMBING 1 SIG���R[NKLER/ DEMOLITION <br /> CtTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR SiREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-$857 {(E}everetteps@everettwa.gov( www.everetiwa.gov/perrnits <br /> (Btue or Btack inK Only Pleasej PROJECT Sl'�E IN�ORMATIVN <br /> PROJECT SRE ADDRESS: �j� �j�� 5 t. �' 19G PROPER'i'Y TAX�: $Q�j�Qpapo�'pp <br /> LEGAL for new construc6on; Short P(aUsubdivision lot No. (attach copy of long tegal description) <br /> CONTACT INFORMATION <br /> OWNER PfAME: LI�G{� P�� �1,,,�{�'q �/��„�,p� �.�„e. �NANT NAME(If Commercial): i�✓�(,��t j. p{0�9�{E <br /> OWNER MAlLING AbDRESS: srr�Er 7•4�( $�, oZ%ffi-�"f 5�1'�E oZB <br /> cmr i�.o4E j�C�'F�i %S�.p NL) STATE 1.9J�- ZIP ej gO <br /> OWNER PNONE: �o1.b'., �6l4 ' 0'1 pWNER EMA1L: c7U ZI� �p�raNRREA1.rsTl�rr".COIYi <br /> CONTRACTORNAME: c /�tN�p �v�ST ��i� - <br /> COIVTRACi'OR ADDRESS: s�� �(�y'� �����,��j, <br /> cmr StA 1. = s,�n� ��- zia �8i `v <br /> COEdTRACTOR PHO[�fE: o'�d�•�{c"�-(S/,aQ� COM'RACTOR EMAIL: t,��;�'i��{�P�CQ'��"„y�}}pa.��djy8 <br /> CONTRAC'i'OR LtCENSE#(REQUIRED): C�R RI��C7�ra�� CITY OF EVERETT BUStNESS LiCENSE#(REQUlRED):��5/,7Q�1 <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Speeify} <br /> COM'ACT NAME: CdN'CACY PHONE: �.t".���- ���� <br /> C��G�' Q. C�R13/�h,1CC� � <br /> COldTACTEMAIL: CK�AF�i1�A�C�M/�lL.CC?I� <br /> BUfLDtNG PERNItT APPLICATIOt� <br /> Existi�g Use of Buiidin : Contract Price of Work:$ � �o��°✓ <br /> Proposed Use of Building: Fteat Source: L7Gas ❑Etectric ❑Other <br /> Building Type: ❑SFR Detached ❑SFt2 AtEached ❑Duplex C1Mu{ti-Family-#of Units: C1Commerciai ❑Industria! <br /> Type of Pr4jec� ❑New �Addition ❑Remodel C7Repair �T_!. ❑Sign ❑Sprinkter ❑Demol"�ion ❑Change of Use <br /> DESCRIPTION OF WORK: �NgTAU- M+�N v�AcT��t�O NON� ��1 ��a T�� M�4NV FAG7U R bQ 1�bWIE I�ARK <br /> w/ 8'X!� F-�fihrrt�iNG t��C'j�C <br /> ��►�'X�46'FR�S'Ti�u�o�� cs�►r�voo�t' <br /> ASSOCIATED SllILDING PERMiT#('�fi applicable): <br /> MECHANICAL PERMIT APPLICATfON WLUMBING PERMIT/�PPLICA'�'IOMI <br /> Type af Project: B1ew _ qddn Alteretion Repair Type of Projeci; New Addn Alteratio� _Repair <br /> #of #of <br /> List of�xfures #°f #of <br /> Fixfures Fixfures Lisf af Fixfures , Lisf of Fixtores List of Fixfures <br /> Fixfures �xiures <br /> A/C—Air Handting Units Heat Pump Toilet Backflow Preventer(inside Bidg} <br /> ForCed Air SyStemS Unit Heater Bathtub Urinal <br /> Gas Pipin Boiler Lavatary{Wash Basin) Drinking Fountain <br /> Wafer Fieater Reftigerafion Shower Fioor Drain <br /> Gas Freptace Wood Stove }Gfchen Sink&Disposat Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Ctothes Dryer Hookups Othec Ciothes Washer Medicat Gas <br /> Range Hood Water Heater <br /> Exhaust Fan Other: �'qf .G�/ �� <br /> Sink Service/Bar/MopJetc.) OtheC ( <br /> SPRINKLER I SUPPRESSI�N SYSTEM <br /> Number of Heads <br /> acxnrowcEDCEn�Enn:�nave rev;ewed n,ts appfrcation and confrrm fhe information contained herein is trtre and correct Work done pursuant to fhis permit m�st cromply with <br /> Curreni federdl,Shdte,and IOC2t 18W.Thg granSng of a permit onty authorizes approved work and no deviations therefiom.Devia6ons must first be authorized in writing from the <br /> 8m7tling OfTicta(6efore being authorized under any c;,cumsfance 1 am the ov�ner,or 1 am authorized by the owner of fhis properfy to perfo�m the work for which epplJCetiOn iS tI78d6, <br /> and 1 comply rvith the State Conhactors Law 18 27 RCW and 296.200A WAC. <br /> Cify of Evereff O�ciaf Use Only <br /> PERMIT#�'���I' (t'1 O� <br /> ..�/a'��"�- V <br /> �tlAuthoriz Agent 5ignature Date (Revised 5/20/2076) <br /> � I� <br /> ,� _1 <br />