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PERMIT APPLICATION <br />BUILDING:, iitECHANICAL / PLUMBING / SIGN / t11 111INKLER / 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 />PFtO.JECT SITE ADDRESS: 7&( j �7 4r�.lt�t�i -t�� �JiG� t`t WIa PROPERTY TAX # � �( I0 <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: i ' (4At TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET 7D01;_1 <br />CITY !' Jr STATE w* ZIP -I Y-2-0 <br />OWNER PHONE: ZS , -1 Z--Z qC? <br />OWNER EMAIL: iC.Lt✓�iz;L� IL r.1, <br />CONTRACTOR NAME; <br />CONTRACTOR ADDRESS: STREET '�Zcj <br />CITYSTATE V V y�- ZIP <br />CONTRACTOR PHONE: CONTRACTOR EMAIL: �iTl . Ir�STT,25�, c� eJ <br />CONTRACTOR LICENSE *(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: OJWNER OCONTRACTOR THEIR (Please Specify) <br />CONTACT NAME: <br />c `v►.%� V V-FLp— HLz'Vwd-p1(,4—. <br />CONTACT PHONE:Cn <br />CONTACT EMAIL: 71k AAL-- , " . <br />BUILDING PERMIT APPLICATION <br />Existir � Use of Building: ✓\,.-�"— WT <br />Contract Priice of Work: $ 7 <br />Promised Use of Building: ���,cr2/�. t'�- _ <br />�OPuplex <br />Heat Source: _ �as �lectric ather <br />Building Type: nFR-Detached EIFR-Attached ❑,iVulti-Famil -# of Units: mmercial Ondustrial <br />Type of Project: Olew E lddition ®temodel aepair I. Eli n Elprinkler Elemolition Ebhan a of Use <br />DESCRIPTION OF WORK:___ _ <br />1v, S ►-ekJ 10 <br />ASSOCIATED BUILDING PERIMIIT # (if applicable): 0 Z2 <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: XNew _,•• Addn Alteration _Repair <br />Type of Project: _New Adldn _Alteration _Repair <br /># of <br />Fixtures <br />1 <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />Last of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br />Y _^ <br />A/C -Air Handling Units <br />_ <br />Heat Purnp <br />t Toile <br />Backflow Preventer (Inside Bldg) <br />I <br />Forced Air Systems <br />Unit Heater <br />Bathtub <br />^! <br />Urinal <br />Gas Piping_ <br />Boiler __ _Y <br />Lavatorr(Wash Basin) <br />Drinking Fountain <br />Water Heater <br />Refri eratiori <br />Shower <br />Floor Drain <br />Gas Fireplace <br />Wood Stove <br />Kitchen Sink & Disposal <br />Grease Trap <br />j <br />Gas Range <br />ITRE <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 />_ <br />q �SPRINIKLER <br />_ <br />Exhaust Fan <br />TMT� <br />Sink (Service/Bar/Mop/etc.) <br />r <br />Other: <br />/ SUPPRESSION <br />SYSTEM <br />_ <br />Chemical or Water <br />No. of Heeds �a <br />ACKNOW( EDGEMENT: 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 Offici before being authorized under any circumstance. i am the owner, or 1 am authorized by Me owner of this property to perform the work for which application is made, <br />and I com Soivith the State Contractors Law 18.27 RCW and 296, 200A WAC. <br />City of Everett Official Use Only - <br />PERMIT # <br />I �/ (Revised 9/23f2016) <br />