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PERMIT APPLICATION <br /> BUILDIN*ECHANICAL/ PLUMBING / SIGN&RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OL 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)42E-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 12- fir, Get 5 0 0 , PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision �t Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (�{ti'I Q� ct(d 3 1 v f y G-4,& TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 73 ' aAcl St-. + ) <br /> CITY 4CA � 'L-Lq STATE I-I ` ZIP 16-7 <br /> OWNER PHONE: 00.5- q(2 --(rj OWNER EMAIL: qd qj0 b-)d h lie C��F/✓) <br /> CONTRACTOR NAME: i 1"5EF6 p <br /> CONTRACTOR ADDRESS: STREET 40(A-ti (�j�b"� f (� Q,► / <br /> CITY STATE W ZIP �! <br /> CONTRACTOR PHONE: '1, %�� ®�ja� CONTRACTOR EMAIL: (T,Q� <br /> CONTRACTOR LICENSE#(REQUIRED): MLyq©t3-T CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): f!7 <br /> PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR OTHER(Please Specify) OWOC5i <br /> CONTACT NAME: CONTACT PHONE: <br /> (t <br /> .2-0w . <br /> ClT�-�3 }Li CONTACT EMAIL: ada�'1 ZG)�I'1 ' ��G, Gv <br /> BUILDING PERMIT APPLICATION <br /> ExistingUse of Building: v i Contract Price of Work:$ ( �5 G> COU <br /> 9: L vi i � �: �O�G! � <br /> Proposed Use of Building: ScZYYIv Heat Source: ❑Gas E]Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ulti-Family-#of Units: ❑Commercial []Industrial <br /> Type of Project: El New ❑Addition ❑Remodel OrRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> �I 1r, <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/SUPPRESSION SYSTEM <br /> Number 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 /> PERMIT <br /> 21 Lb� <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />