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PERMIT APPLICATION <br /> IP <br /> / PLUMBING / SIGN / NRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OL 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:,�s7 C4& <br /> 4 5 L # PROPERTY TAX#: 00 5-1%3 70 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �, �� N -S k;n TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1-5 Q 31 S} P1 W <br /> CITY l STATE ZIP O <br /> OWNER PHONE: utZ S �j cj o? `7 Co OWNER EMAIL: <br /> CONTRACTOR NAME. AJr-Qt i,*U�C-CS <br /> CONTRACTOR ADDRESS: STREET q(p J <br /> CITY 6&cd"ASTATE Wk ZIP -` 3 <br /> CONTRACTOR PHONE: aQ 3,2d- 95 ICS 1CONTRACTOR EMAIL:, f t flofaiC 7G�'u1L2S,c�>m <br /> CONTRACTOR LICENSE#(REQUIRED): ,J P\o 15 11 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: O OWNER @'CONTRACTOR O OTHER(Please Specify) <br /> CONTACT NAME: J v 1`vn� CONTACT PHONE: aQ(� S - �s�(� ��C Ile <br /> C� CONTACT EMAIL: r �W�� .� ,�. � cf'yn <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: L,) Fe nniL T? 1 1105 Contract Price of Work:$ 3 L'e, <br /> Proposed Use of Building: Heat Source: M Gas O Electric O Other <br /> Building Type: O SFR-Detached O SFR-Attached O Duplex Multi-Family-#of Units: J O Commercial O Industrial <br /> Type of Project: O New O Addition O Remodel Repair O T.I. O Sign O Sprinkler O Demolition O Change of Use <br /> DESCRIPTION OF WORK: yy i <br /> R : v,(\k+5 ri�6,vmst:rJl b.t sn okt i;\ytu-S'on VL+' P,ncj�Uzi <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.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 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 /> 3LC� 13 &IS <br /> Owner/Authorize Agent Signature Date (Revised 10/12/2015) <br />