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• <br /> PERMIT APPLICATION <br /> ziv....,I. IP:=di BUILDING l MECHANICAL/ PLUMBING /SION I SPRINKLER/ DtrillOLITION <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 I www,everettwa.gov/per-nits <br /> IVI <br /> (Blue or BIuck!plc Only11Please) PIROJECT SITE INFORMATION ii -. <br /> R OJECT SITE ADDRESS i 0b r/2 � 0 V PROPERTY TAX#:0moiG', ipectoo� <br /> LEGAL for new construction: Short Plat/subdivision Lot No, (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Ilye/it "hid- TENANT NAME(If Commercial): _ . _ __ <br /> OWNER MAILING ADDRESS: STREET wit tom-4 SE illn <br /> 4u <br /> COY Ar STATE i 14 ZIP <br /> r 6 1 <br /> OWNER PHONE: J(.Q--`716-`I Jc,COWNER EMAIL: i <br /> CONTRACTOR NAME: UJ 51_f/A)6 t ) J (4j/11--Tr)L 1.-16-43761F--5 <br /> 1-7/ 2_ (I+C,1.h A-yre, .- 'CJ ,iUX 9 <br /> CONTRACTOR ADDRESS: MEET <br /> Orr( fPail STATE VA- <br /> mi., <br /> q1OC)ss <br /> CONTRACTOR PHONE: 426— g3' ( OtCONTRACT : (C-ot (tm <br /> CONTRACTOR LICENSE#REQUIRED): W} Jkgpl CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 3V-17162. <br /> PRIMARY CONTACT: 0 OWNERI .CONTRACTOR 0 OTHER(Please Specify) - w.t <br /> CONTACT NAME• CONTACT PHONE: 02- 4.,.:3.-C/'7/ <br /> c,i JtJU-t ISCONTACT EMAIL: to 'LtJftlL.1 ' ( L•(e-04 ., <br /> BUILDING PERMIT.A.PPI IU:A`t;ICiN <br /> Existing Use of Building: . (111_. VI 0 f Contract Price of Wv=�- •,;� <br /> Prop0$ed Use of Building: Heat Source: OGas -17feleCtriC ❑Other <br /> Duilding Type: IEr ri,Dataohod ❑SFR Attoohod ❑Duplcoc OMulti Family-1f of Units:_l___ f C'tnmmarrial �asrttr Fllnrf i I <br /> Typo of Projoct: ❑N1ew ❑Addition ❑AAmodel tJRepair�riT I fFirjn F1Rprinkipr f hprnnlitinn f c hnnopof Se ''L I re (1 E <br /> DESCRIP ON OF WORK: \., �-- . <br /> R <br /> vz49/1-a_ 1 &Ili t P?L WV / ,-t,( <br /> ASSOCIATED BUILDING PERMIT#(if applicahle) <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATl ON <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn • AIterattp _Repair !/{i[). <br /> #Of *-------- <br /> List OT rrxrw-es #Of t..rsr or rfxrures #of Lrr,t VA rrr.rve do #of L'nr Arl..k,, '�'!� r <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC-Air Handling Units i Heat Pump _ ' Toilet Backflow P eventer(Inside Bldg) <br /> . Forced T Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fd ntain <br /> Water Heater Refrigeration Shower Floor Drain: ....• . <br /> Gas Fireplace - Wood Stove _ Kitchen Sink&Disposal Grease Tra'. <br /> Gas Range Ducting Dishwasher Roof Drain- <br /> Clothes Dryer Hookups Other: Clothes Washer Medical G . <br /> Range Hood Water Heater Other: . <br /> Exhaust Pan Sink(Service/Bar/Mop/etc) Other: <br /> • SPRINKLER/SUPPRESSION SYSTEM <br /> Numberof Heads <br /> AC KNOWI-EDGEA4ENT::t have reviewed this application and confirm the inforrtration contained herein Is true and correct.Work done pursuant to this p4 mit must comply with <br /> current federal,abate,end lace!law.The granting o _ .armif only authorizes approved work'and no deviations therefrom.Deviation must first be author•ed in writing from the <br /> Building Official before being authorized under en ;urnstance.I am the owner,or/em authorized by the owner of this property fo perform the work fo which application is made, <br /> :••I comply with the State contractor w Raz -•or 296..200A wAC. <br /> ICity of Everett Office;.l Use Only <br /> C <br /> Alb .' I (4. [ 2 i PERMIT.• \). 2 �S <br /> i <br /> nor/Authorized Agent Signature Date (Revised 5120/2016) <br />