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PERMIT APPLICATIOI�� <br /> BUILDING �CHANICAL/ PLUMBING /SIGN �INKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> (Blue orNBlack Ink�O'nly Pfea�`se); �,z4 - PROJECT SITE�NFORMATION „�� _ . ; a ���_.; _ _ <br /> ,� , x . _ � �.�,,:� <br /> ��:�,�. <br /> PROJECT SITE ADDRESS: ��2,5 C�p b PROPERTY TAX#: 3�[7 '] � 2 Q <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> ._ � z �,, � n_s . � <br /> '�.�, 'ti.. ... ' �.:. CON,T,ACT INFORMAT.,ION � `` <br /> OWNER NAME: �� -�- -��� p-� TENANT NAME(If Commercial): ( � S�o �'�✓� <br /> OWNER MAILING ADDRESS: sTReeT <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME; �� ��,' <br /> CONTRACTOR ADDRESS: sTReer � (� �j�,�.g� S'�' <br /> CITY ^h^�"t STATE ZIP �� ��� <br /> CONTRACTOR PHONE: (� - �6 - S CONTRACTOR EMAIL: _ k„�,,y� � �,,,� <br /> CONTRACTOR LICENSE#(RECIUIRED): t}�/ sG� CITY OF EVERETT BUSINESS LICENSE#(REQUIR D): QIFSSEritl' <br /> __, ,.. . . ._ <br /> __ _ _ ._ . _., . . . __ _,_ _r ._ <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �6_���_��� <br /> ��,►�Li�( lC�W+ CONTACT EMAIL: ` <br /> �✓' � <br /> � .� � � �.�� �s ., <br /> :;xBU1LDING.PERMIT,APPLIC�►TION ;_��., , ` - <br /> Existing Use of Building: Contract Price ork:$ 36 O�S <br /> Proposed Use of Building: Heat Source: as ❑Electric ❑ er <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of ' ommercial ❑Industrial , <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair 7.1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: `�5..�-��� CZ� �ew �^o�'�'.o� 5c��p�p�.�i-�L �G w�i fi-S G�v� GisScx..ia;F'e� <br /> 0'�t�p�"I-wo C'�C. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> ' NIECHANICAL PERMIT,APPLICATION ' ' PLUMBING'PERMIT APPLICATION <br /> Type of Project: _New _ Addn XAlteration _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 /> 2., 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/,S_UPPRESSION SYSTEM,`, . <br /> Chemical or Water No. 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/ocal 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.1 am Ehe owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18:27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> P RMIT# <br /> �� � o /�6i l� c � n - a��-f ` � <br /> Ow uthori ed Agent Signature Date (Revised 9/23/2016) <br />