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RMIT APP ICA 01 �I <br /> BUILDIKI 1 MECHANI AL l PLUMBING I SIG RINKLER/ DEMOLITION <br /> IIIW <br /> vial C TY OF EVERETT PERMIT 'VICES <br /> 3200 R STRE TT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:IS-a3J-Z__ =SS-t— C PROPERTY TAX#:Z.8 OS'-8E.7,6(:)4,5&, 0 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: i i til ,• r„J PO TENANTNTNAME(If Commercial): Li---Le. r <br /> OWNER MAILING ADDRESS: STREET `a',�c b E1/ {� fth—t. °ems <br /> ,.;....-,p ,. CITY [j) - o°''�j� <br /> V�'�-E;i TATE �°•vJ[a'�} ZIP <br /> OWNER PHONE: 31.6 -l L, i -L 3 OWNER EMAIL:- Abt9 TS e:. CCW\C-A ('- OE <br /> CONTRACTOR NAME: V t� t 6Rik,3 Se3 <br /> CONTRACTOR ADDRESS: STREET Z...c (A) 4., `C:I RA Iv :A 12-- 7 <br /> CIN . ,. _Asa STATE A' S�a ZIP 8 3. <br /> CONTRACTOR PHONE:1_2)G-?j i - -- CONTRACTOR EMAIL: t)1a = _j_ I <br /> CONTRACTOR LICENSE#(REQUIRED): /�t � , •.( C. CITY OF EVERETT BUSINESS LICENSE/ARE* IRED): iii, 7 __ <br /> 10 <br /> PRIMARY CONTACT DWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT-CN E: CONTACT PHONE: i, o_9�i -.2 5�- <br /> I I A,v...*.._( CONTACT EMAIL ` <br /> BUILDING PERMIT APPLICATION PP- 00 <br /> ryi <br /> Existing Use of Building: �/ACAC31 • f' ,`,til._ Contract Price of Wor,-: Ate = �T1 �� <br /> Proposed Use of Building: Li.1 t ; (mss z_Zjs, Heat Source: _'s a- lectric De <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units. _ ommercial ❑Industrial <br /> Type of Projectelew ❑Addition ❑Remodel ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WOR ; Lime 1 ,T ' m <br /> 2s 7_ pw s 6.,,,,,(5i 0,, <br /> w A.Lx_- A rl?.� -Too c_e_av`?a-('U 1, E( I ?Z.t rs r C' <br /> ASSOCIATED BUILDING PERMIT#(ifap.licable): ,' i A All R• D 1.-10(0-0 • <br /> III. <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 o, .ixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heatr i`;pToilet —Backflow Preventer(Inside Bldg) <br /> Forced Air Systems ,Wit Heat Bathtub _Urinal <br /> Gas Piping , Boiler / a Lavatory(VVash Basin) Drinking Fountain <br /> Water Heater ,,, aeration Shower MI'Floor Drain <br /> Gas Fireplace ._' f ood Stove Kitchen Sink&Disposal NM Grease Trap <br /> Gas Range _, Ducting Dishwasher Roof Drains <br /> Clothes Dryer,13I6.• es Other: Clothes Washer —Medical Gas <br /> Range How stmazEmm- —Other: <br /> Exhaustan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION,SYSTEM <br /> Chemical or Water 9 No. of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application an' .onfirm 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 per t o ly authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized nder any circu f to ca l 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 Contractor - .27 RC /ani 296.200A WAC. <br /> City of Everett Official Use Only <br /> V 11 PERMIT#A bUsr D5� <br /> Owner/AuthorizedAt-ntSignature i \bo0 (Revised 9/23/2016) <br />