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I, PERMIT, APPLICATI <br /> ;�' ' BUILDII MECHANICAL I PLUMBING I SIG RINKLER/DEMOLITION <br /> ` '' CITY OF EVERETT PERMIT SERVICES <br /> _ r 3200 CEDAR STREET,EVERE I i,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 r(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1523 82,74 6* stm ,Q PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision •Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: in TENANT NAME(If Commercial): LMIAs Lour►9� <br /> OWNER MAILING ADDRESS: STREET 15't 3132 Ge? €,, ,)Or_ A v <br /> cnv EA(.0(64}- STATE 1,A}po ZIP 7 r20 ' <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: CYOWn cwt.., 'tu I n` <br /> CONTRACTOR ADDRESS: sTREEr PC co)( 12-1%5 <br /> CITY 1/11►1\ Urea-. • STATE Wilt ZIP g to 11Q <br /> Z <br /> CONTRACTOR PHONE: 415.Lig 0 641 CONTRACTOR EMAIL: `•C 56‘ O€,.f Thu* . Corn <br /> CONTRACTOR LICENSE#(REQUIRED): �.��RI•J✓p1 poy yu, CITY OF EVERETT✓ BUSINESS LICENSE#(REQUIRED):bSeA7 <br /> PRIMARY CONTACT: 0 OWNER }CONTRACTOR 0 OTHER(Please Specify) <br /> • <br /> CONTACT NAME: CONTACT PHONE: /425. g).��/_(,� <br /> J-eSstca�nsan CONTACT EMAIL: ' jC , cr / -p.CO" <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: CQYywr ierev1, Contract Price of Work:$ 3,e c c.op 1 <br /> Proposed Use of Building: LOYMPCXHeat Source: OGas DElectric DOther <br /> Building Type: OSFR-Detached OSFR Attached ©Duplex DMuiti-Family-#of Units: Commercial ❑Industrial <br /> Type of Project ONew OAddition ORemodel DRepair -.l. OSign )54prinkler ODemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Md. 214 sir m?pier head, <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 /> Fixtesu List of Fixtures y ores List of Fixtures Fixtures es List of Fixtures FixturesList of Fixtures <br /> NC—Air Handling Units Heat Pump . ' Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater e - Bathtub Urinal <br /> Gas Piping Boiler -4 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 /> t <br /> 1 <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> 'Chemical or Water I No.of Heads - <br /> ACKNOWLEDGEMENT::I have reviewed thisapplication and confirm the information contained herein is true and correct.Work done 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 1 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 296200A WAC. <br /> • , <br /> City of Everett Official Use'Only <br /> - PERMIT# <br /> 7.23.1� �L �l OA <br /> qedliCa--,'Ala•ifW)101 <br /> uthorized Agentre Date {Revised 9/23/2096) ' (1 k-I . \ <br />