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PERMIT APPLICATION <br />BUIL.DING �CHANICAL ! PLUMBING 1 SlGfV I�INKLER / DEMOLITION <br />C17Y OF EVFftETT PERMIT SFf�VICE. <br />3200 CEDAf2 STR�ET, E:VERC"fT, 1NA 98201 <br />(P) A25-257-IIII10 � FAX 425-257-8857 �(E) everetteps�Y?everetlwa.gov � www.cvereltwa.gov/permits <br />PROJECT SITE 1NFORMATION <br />PROJECT SITE ADDRESS: �� PROPERTY TAX #: <br />00 8 a �a 000c7o-zoo <br />LEGAL for new construction: Short Plat/s�.ibdivision__ ____ ___._.Lot No.,___, (aftach copy of lonq legal descriptionj <br />CONTACT INFORMATION <br />OWNER NAME: j��C¢�D,R_Q_ ��jC�X"vv TENAN7 NAME (If Commerciai): <br />OWNER MAILING ADDRESS: sTaeer J� Q � <br />�,T., SIATE ��� a�oy <br />OWNER PHONE:� �( �S_ a i a-g�r �� OWNER EMAIL: b��j(,t,1rr1 'UQ , C,6�yy <br />CONTRACTOR NAME: �',Qti- -gn� J�'1C,. <br />C(�NTRACTORADDRESS: ,rreeer E"%Ip2�j k���"� cS,� �"IY�j� <br />CI7Y qBt% �� 5Tl�TC-. W� �� Zlf' %CJVIp� <br />CONTRAC7nR PHON�: '/o�" — �� .., a�// CONTRACTOR EMAIL: cS�i��4@��'"�"�%'%�S''7��!'�% ���'''��_ <br />CON7RAGTOf2 L.ICENS� #(RFC�UIRED); CARjJ,�� O�..',LL' CIFY OF EVERETT BUSINESS LICENSE �t(RE(�UIRED): (� a <br />PRIMARY CONTAC7; ❑ QWNEF� CONTRAGTQF� ❑ QTHER (�'lease Specify) ________�,,,,,,,.._____.._�� <br />CONTACT NAME: ���� m���� CONTACT PHONE: ,2p �..- g(� .•-�a <br />CQNTACT EMAIL: �.-�� C;��y.��� y• �,pr�``- <br />BUILDING PERMfT APPLICATION <br />Existing Use of E3uilding: �.�i�.g yy�Q� Contract Price of Work: $__.l 8�.:._.D� <br />Propc�sed Usc: of Building: Heat Sourr,e: �Gas ❑�lectric ❑Other <br />E3uilding Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex C�Multi-Family-# of Units; ___ C7Cornmercial ❑Industrial <br />Type of Project: [�New ❑Addition ClRemodel ❑Repair C17.1. ❑Sigr� OSprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />�,�,U,,.e � ,s�,,��� �--�. � . I��� ,.�� �'� �. <br />ASSOCIA7ED BUILDING PERMIT # (if applicable : <br />MECHANICAL PERMIT APPLtCAT10N PLUMBING PERMIT APPLICATION <br />Type of Project: �New � Addn ____Alteration �Repair Type of Project: �„_,tJew Addn __Alteration _Repair <br /># of # of # of # of <br />Fixtures List of Fixtures Fixrures ��sf of Fixfures Fixtures List of Fixtures Fixtures List o/ Fixtures <br />A/C - Air Handling Units Heat Pump Toilet Backfiow Preventer Inside Bldg) <br />Forc,ed Air S ster7�s Unit Heater Bathtub Urinal <br />Gas Piping Boiler Lavatory (Wash Sasin) Drinkin Fountain <br />Water Heater Refrigeration Shower Floor Drain <br />Gas Fireplace VVood Stove Kitchen Sink & Disposal Grease Trap <br />Gas Ranye Ducting Dishwasher Roof Drains <br />Clothes Dryer Hookups Oiher: Clothes Washer Medical Gas <br />Range Hood Water Heater Othcr. <br />Exhausi Fan Sink (Service/Bar/Mop/ctc.) Oiher <br />5PRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />ACf<NOW1.E(�GEMFNT: 1 lrave reviewed (hrs applicaGon and conlirm the information confained herein is frue and correct. Work done pursuant fo lhis pemvt must comply with <br />current federal, state, and local law. The granting of a permrt only authorizes approved work and i�o deviations therefronz Deviations must (irst be aulhorized ir1 wrifing hor1� the <br />l3�ulding Official betoio beiny autho�ized undei any circumstanco. ! am the owner, or 1 am authorized by !he ownor of this properly fo perform fhe work (or which applicalion is mude, <br />and ! comply with the Staie Contractors Law 1fJ.27 RGW and 29G.200A WAC. <br />: • <br />-------- <br />Owner/Ai tiorized Ageni Signature <br />City olEv�r�tt Official Use Only <br />PERMIT ik <br />� ao�r� �1 �ODa-O <br />Dat {Revrscd 90/12/2015) <br />