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PERMIT ' PP0_OC.ATII <br /> fit UIL®0NG I MECHANICAL/ PLUMt=(NG /SIGN/SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> P 425-257-8810 i FAX 425-257-8857 I(E)everetteps@everettwa.gov] www.everettwa.gov/permits <br /> Woe or lOack Ink Only Please) PROJECT SITE IN FORMATION <br /> PROJECT SITE ADDRESS: 3J� � / �- PROPERTY TAX#: �j ��gO��O� <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMAT11 N <br /> OWNER NAME: Y)4 5 14 Ewe)? TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Z3!1-11749-7ea. 5T <br /> cmC.VET_ STATE (Alir ZIP gQ(y <br /> / Q <br /> OWNER PHONE: L(J 6--ge3—Q3(17 OWNER EMAIL: <br /> CONTRACTOR NAME: DAV V--/U/76- PLci/467.4) - gi--HEAT11i& <br /> CONTRACTOR ADDRESS: STREET /4` 44 /3, , .qct, Gv <br /> CITY Li A/AIWOOA STATE UM ZIP q 8V37 <br /> CONTRACTOR PHONE:4-12 715--646 CONTRACTOR EMAIL: 43i4f 0_17,4A.offoo jJ17 E, N <br /> CONTRACTOR LICENSE#(REQUIRED): , /p/z'PI+q CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): V ici-744 I <br /> PRIMARY CONTACT: 0 OWNER RCONTRACTOR 0 OTHER(Please Specify) T3,&Y4AI kAtel-C <br /> CONTACT� NAME: 6 �� CONTACT PHONE: /42..5_715_6 lib q <br /> I _ d.,�l Z Y C. 4- 0 CONTACT EMAIL: 12 <br /> l(2/Vh7`I Cds1 rt`T v OJ" 17 'P <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 3 893,ero <br /> =Proposed Use of Building: Heat Source: ❑Gas ❑Electric El Other <br /> Building Type: ❑SFR-Detached SFR-Attached DDuplex ❑Multi-Family#of Units: ❑Commercial El Industrial <br /> Type of Project: DNew DAddition DRemodel DRepair DT.I. DSign DSprinkler DDemolition DChange of Use <br /> DESCRIPTION OF WORK: .T'T,i,r,T _ A-7,/e44) �Jl.rC- 5.0014. A- i1�i� .ce. fi ife L l } <br /> A- New 7izosr ' 1165 131131:5, <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 #°{ List of Fixtures #°f List of Fixtures #°f 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 1 Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> 1 Clothes Dryer Hookups Other: • Clothes Washer Medical Gas <br /> Range Hood Water Heater I Other:. /1Vi(CaC..Li we_ <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) ( Other: Hose 03 1 Kg <br /> SPRINKLE=: /SUPPRESSIQN SYSTEM <br /> Chemical or Water 1. 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 /> .frrent 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 /> wilding Official before being authorized under any circumstance.I am the owner,or!am authorized by the owner of this property to perform the work for which application is made, <br /> nd I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 9 <br /> PERMIT#, <br /> i / // 1 ' 1D l g C—0�7il <br /> Owner .rized Agent Signature 7 <br /> I� Da'- (Revised 9/232016) <br />