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MAW <br />PERMIT APPLICATIO <br />BUILDINAECHANICAL / PLUMBING / SIGN 1RINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />(Blue or Black Ink Only Please PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: ' , , R vatr ie l � 4-c, re 1^1A � a <br />PROPERTY TAX #: OQ0?3,_i 7p 7Cf C� <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description& f,GC,l <br />CONTACT INFORMATION <br />OWNER NAME: %l �,. i� � ��r� � "� -� .� ,.- , .. rr TENANT NAME (If Commercial): Kx = ✓ a. �6r, �'� 1 :L,' <br />OWNER MAILING ADDRESS: STREET �^�: �i �5 / 47' / �:- <br />CITY ' STATE ZIP <br />OWNER PHONE: <br />OWNER EMAIL: ,.--A, ..o;c- r: / jh C;�"c'e"s°1D�C�/C � ke" c ov! <br />CONTRACTOR NAME: 78D <br />CONTRACTOR ADDRESS: STREET <br />crrY STATE ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />., :. <br />CONTACT PHONE: <br />CONTACT EMAIL: // <br />+'h /`4- c,!/h c-C; ,:-�r,M� i�!G�`P w <br />PERMIT APPLICATION <br />/BUILDING <br />Existing Use of Building: ex7'iQa ,- q 4 <br />Contract Price of Work: $ � v <br />Proposed Use of Building: a s/ma ran <br />Heat Source: .QIGas ❑Electric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached []Duplex ❑Multi -Family- # of Units: kdCommercial ❑Industrial <br />Type of Project: ❑New ❑Addition WRemodel ❑Repair ❑T.L ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />4 Judd' �7t'�Y �sCcbse._ <br />ASSOCIATED BUILDING PERMIT # if applicable): <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New Addn _Alteration Repair <br />Type of Project: _New Addn _Alteration _Repair <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br />A/C — Air Handling Units <br />Heat Pump <br />Toilet <br />Backflow Preventer (Inside Bldg) <br />Forced Air Systems <br />Unit Heater <br />Bathtub <br />Urinal <br />Gas Piping <br />Boiler <br />Lavatory (Wash Basin) <br />Drinking Fountain <br />Water Heater <br />Refrigeration <br />Shower <br />Floor Drain <br />Gas Fireplace <br />Wood Stove <br />Kitchen Sink & Disposal <br />Grease Trap <br />Gas Range <br />Ducting <br />Dishwasher <br />Roof Drains <br />Clothes Dryer Hookups <br />Other: <br />Clothes Washer <br />Medical Gas <br />Range Hood <br />Water Heater <br />Other: <br />Exhaust Fan <br />Sink (Service/Bar/Mop/etc.) <br />Other: <br />SPRINKLER <br />/ SUPPRESSION <br />SYSTEM <br />Chemical or Water <br />7-1 <br />No. of Heads <br />ACKNOWLEDGEMENT. -1 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 l am authorized by the owner of this property to perform the work for which application is made, <br />and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City IIof Everett Official Use Only G;h Mook.2d/g PERMIT# L 'V <br />Agent Signature Date (Revised 912312016) <br />