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4arrPL/ PLUM I ING/SIG, 11 <br /> ERMIT • PPLICATI . <br /> BUILDrW MECHANICAL !_,.,.'RINKLER I DEMOLMON <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/permits <br /> (4-km or Mack Ink Only Please) PROJECT SITE I N FORMATION <br /> PROJECT SITE ADDRESS: !6-5).. 1.04D S7 sATiloar,kik 'PROIe'L`-TA : <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> I CONTACT I1�9FORMATI(IN - 1 <br /> O7WNER'NAME t ►`x et„,4 Jj0�,,i vx TENANT NAME(If Commercial ALTI1/1 r-' u`r � <br /> OWNER MAILING ADDRESS: STREET 1CSD it CWu_ )e_ rI <br /> cm ki r klafiet STATE Wit • zIP 9-n33 <br /> OWNER PHONE: 626--)62-33 iS OWNER EMAIL: !cam o.;3 ez pw i1 404 <br /> CONTRACTOR NAME: Wan J pia 1 - G <br /> CONTRACTOR ADDRESS: STREET iics- (16;4ole,_ Alf. <br /> cmi j rk jtu,,a( STATE Wk ZIP ,&e03� <br /> CONTRACTOR PHONE: 626 Zb Z- 1t... CONTRACTOR EMAIL: f iO3,3 ® / ad. <br /> CONTRACTOR LICENSE#(REQUIRED): WA-N.t/iTFg 3 3 ea, CITY OF EVERETT BUSINESS LICENSE� #(REQUIRE : % ,i if <br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) • r <br /> CONTACT NAME: alizawyk CONTACT PHONE: G— 7? � IV-Pit <br /> CONTACT EMAIL:.. o 'l 6 ,c.06^_. <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ Ct c0O 00 <br /> Proposed Use of Building: • Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial El Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair T.I.18:( ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> j-ruel-r'13i WD-rz WD-rGreevir`w1 4/A)0 n'ta6SO fj S ov.e i -ce cry BvLe <br /> ttutr-t room_ <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 #of List of Fixtures #of List of Fixtures #of 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 Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: • Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER I SUPP ESSI a,N 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 /> 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 I 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 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERF f 1` O22 <br /> 0 t <br /> n <br /> Owne ut oze et/t/v1 Yfrv\-r- 1.nt Signature ate �� (Revised 9/23/209 <br /> 9 <br />