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PERMIT APPLICATI <br /> BUILDS I / MECHANICAL/ PLUMBING /SIG MPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> elETT <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) c� PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:/4( S' (S:z S L S(:' ✓t:Cs.1( C1 3 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Y/f)LI NIA IQ) 44/1 44 TENANT NAME(If Commercial): jp,( _ k— <br /> OWNER MAILING ADDRESS: STREET f -- I S' S n of 3 '- / /� <br /> CITY Jo)2( t ( /(STATE (/�/fel ZIP q ` (� 3 <br /> OWNER PHONE: QOb4 2� I ) OWNER EMAIL:L=1�eras-iq r C...(6)(9 pita"- ( " coal <br /> CONTRACTOR NAME: ,Z40:44 COOL R.0 Nt N S <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: 36 0 '1 C C C( CONTRACTOR EMAIL:Ld 0l C <br /> CONTRACTOR LICENSE#(REQUIRED):C001 fr.G5(03/3q-- CITY OF EVERETT BUSINESS LICENSE#(REQUIRE ): fa$C <br /> PRIMARY CONTACT: [,OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> CONTACT PHONE: 3 6 03c/ <br /> g g fl / 4 <br /> bow Caw\toe t( CONTACT EMAIL: C 11Z_r2 C 193 t3 L f CO C1 !rico) ( c, , <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ . <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric DiOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel El Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: COrJVr✓�?'.i' �( <br /> l� )cduA,Le t n V\/L' Ae7O4-1-' F'A-V1i1 I e...14, <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 #of #of I #of <br /> List of Fixtures List of Fixtures List of Fixtures 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 /> Chemical or Water I No.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!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> / 9 3 /.2© t//z'/ � PER #�\ � 0� � <br /> ner/Authorized Agent Signature (/ Date (Revise 1 J <br /> \,V <br />