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� I'ERMIT APPLIGATIO� <br />BUILDIN�/ iV1ECHANICAL. / PLUNiBIMG / SIGN �PRINKLER / DEi�IOLII"ION <br />CITY OF EVERETT PERMIT SERVICES <br />E 3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />,: <br />; ,. <br />_ : ' ; - . PROJEC7' SIR'E IIVFORMATIOPd -: <br />- - _.:, -...:., <br />-_...,.._. <br />PROJ C�T SITE ADDRES� � £. � ` �,�. � � PROPERTY TAX #: <br />� res ac <br />LEGAL for new construction: Short Platlsubdivision Lot No. (attach copy of long legal description) <br />OWNER NAME: <br />OWNER MAILING ADDRESS: sTrtEEr <br />CITY <br />�NER PHONE: <br />NTRACTOR NAME: Co 6s� �i.nrr�v. <br />NTRACTOR ADDRESS: srReEr �p. <br />TENANT NAME (If Comm <br />OWNER EMAIL; <br />� <br />STATE <br />ZIP <br />_ . ... . ....._ <br />CITY STATE ZIP ��20.�7 <br />ONTRACTOR PHONE: ��5� -ZS� •�%� J CONTRACTOR EMAIL: 1�'G �� 6��' �"'���""� ""�- c.'rl <br />ONTRACTOR LICENSE #(REQUIR <br />RIMARY CONTACT: ❑ OWNER <br />ONTACT NAME: <br />�,; �� �v�����y <br />pOD - O.'({e �� 4 D CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): � <br />CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT PHONE: �E`- �' '�3 �' O S LL� <br />CONTACT EMAIL: 'Q,� s� Cvdrtl -�'oNs!y��o.v, ce�y <br />_ <br />, , : :-: <br />° ? . B.U,ILDING.. PERMIT �APPLICATION :: <br />, ,. <br />_.., _: <br />: _ -. , . ,.. . <br />Existing Use of Building: /?�s{ S� J� Contract Price of Work: d'1�� � <br />Proposed Use of Building: �ec S 7`0�- Heat Source: ❑Gas ❑Electric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Dupiex ❑Multi-Family-# of Units: �Commercial ❑Industrial <br />Type of Project: ❑New ❑Addition ❑Remodel Repair ❑T,I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: �� �ro,rc �tY•••�. ���y• �u •� G`ftj �A�� �(��� �.LT.s�I si��• <br />d <br />4SSOCIATED BUlLDWG PERMIT #(if applicable): /y, fi• _ <br />MECHANIC.AL PERMIT APPLICATION;' °:: PWMBIN.G PERtNIT APPLICATION:`' .`. � <br />_ <br />fype of Project: ^New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br />#°f Lfst of Fixtures #�f List of Fixtures #°f List of Fixtures # of List of Fixtures <br />Fixtures Fixtures Fixtures Fixtures <br />q1C —Air Handling Units Heat Pump Toilet Backflow Preventer (Insi� <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 />.., _�,___ �_.__ ��__�...__ r,+�o�• Clothes Washer Medical Gas <br />� <br />i� <br />Water Heater <br />— <br />;S;PRINKLER /,;SUPPRESSI�N SYSTEM: ` <br />Number of Heads � <br />ACKNOWLEDGEMENT.• 1 have reviewed this application and confirm the information contained herein is frue and correct. Work done pursuant fo this permit musf comply with <br />current federal, state, and locallaw. The granting of a permit only authorizes approved work and no deviations therefrom. Deviations must firsf be authorrzed in writing from the <br />Building Official before being authorized under any circumstance. 1 am the owner, or! am authorized by the owner of fhis property to perform tire work for which application is made, <br />and l�mply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Evereti Official Use Only <br />, PERMIT # <br />,r .'� o � (o D a. - O(o� <br />ner/Authorized Agent Signat� Date (Revised 10/1?J20i5) <br />