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PERMIT APPI_.ICATIOS <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRY NKLER / DEWIOI_FflON <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 bola Only Please) PROJECT SITE INFORMATIOM <br />PROJECT SITE ADDRESS: �((S l�i/C ��y Dud <br />=1- <br />PROPERTY TAX #: gGc�(�?O(� 03 <br />LEGAL for new construction: Short Plat/subdivision Lot No- (attach copy of long legal description) <br />COMTACT [INFORMATIOM <br />OWNER NAME: ( I t.,j .:, - ,� TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET II,S &-vr4 (J J <br />CITY STATE V ZIP <br />OWNER PHONE: 2j 3t - Mq <br />OWNER EMAIL: <br />CONTRACTOR NAME'. Owley— <br />CONTRACTOR ADDRESS: STREET <br />CITY STATE ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: OWNER ❑CONTRACTOR El OTHER (Please Specify) i <br />CONTACT NAIVE: <br />��Ci�Te✓l��� <br />CONTACT PHONE: I <br />CONTACT EMAIL: <br />BUILDING PERMIT APPLICATION _ <br />Existing Use of Building: ✓ o I Contract Price of Work: $ <br />Proposed Use of Building: r� {a✓c <br />Heat Source: QGas ❑Electric ❑Other <br />Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi -Family-# of Units: ❑Commercial ❑Industrial <br />Type of Project: ❑New ❑Addition ERemodel ❑Repair ❑T.L ❑Sign ❑Sprinkler 26emolition ❑Change of Use <br />DESCRIPTION OF WORK: Co-ivev�- DL2se-AC'--�t- Ca.'V"Ir.4-t�- baS3e-�oJ- Vre. ke <br />o Wt 3 L' fC 6 ' r " dt;v a •! be.4� 0, i n S <) 0..e- V.e PG',fJ e C° O '►/eta <br />ASSOCIA1J/TED 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 j <br />Water Heater <br />Refrigeration <br />Shower <br />Floor Drain <br />Gas Fireplace <br />Wood Stove <br />lKitchen 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 I <br />INo. 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 WAG <br />City of Everett Official Use Only <br />PERMIT # <br />2 2q l c60-7--oov <br />Agent Signature Date (Revised 912312016) <br />