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PERMIT APPLICATION <br />BUILDING I CH�NICAL / PLUMBING 1 SIGN /�NKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 4?_5-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS:S�O� �v��y �q�• PROPERTY TAX #: �.Gt ODY%/7 DDOZi �Gd� <br />i�� <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER NAME: <br />OWNER MAILING ADDRESS: srReeT /.35, <br />OWNER PHONE: � �3� <br />CONTRACTOR NAME: 1 � <br />CONTRACTOR ADDRESS <br />CONTACT INFORMATION <br />iQ�f.C�`J TENANT NAME (If Commercial): <br />an �Du� T17N <br />.� 6 -- 6/O 3 <br />a�t �i�c�.�' , GL <br />STREET �D �X, I�S <br />STATE ' <br />EMAIL: J i-1 E/��Q/VC <br />ZIP <br />crrv ,(}6ThCl/ STATE yV ziP � VO <br />CONTRACTOR PHONE• y�r �—,3,3�� CONTRACTOR EMAIL: .=NT�R/OR.S�-�-C �G/f7A/L.COI�'l <br />CONTRACTOR LICENSE #(REQUIRED): �u�L�T� O�! /— 1'V CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): SSS(� <br />PRIMARY CONTACT: OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />Jo,�� �E,�� <br />CONTACT PHONE: 8' �a , <br />CONTACT EMAIL: �M� <br />. G�o3 <br />�� G/i?A/L . Gt7M <br />BUILLIING PERMIT APPLICATION <br />��,�} � � . C; .� <br />Existing Use of Building: ^%��q rice of Work: $ C' e C� <br />Proposed Use of Building: ����e�c� Heat Source: �Gas ❑Electric ❑Other <br />Building Type: FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: ❑Commercial ❑Industrial <br />Type of Project: ❑New ❑Addition emodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: � � <br />/�i� id,� Qe�.v�-•_ ,�i. o) l,x.�G, , la �,-, .2��. ,.1'{��Qyea,.�� �n c�,�..,t/7 �h{�i.+�.r/�a� <br />�" t. Gv�-�.-- �w-� ���J�fi� Lt,�.e%h� a�=���_�� �.j��U/� �., �� d <br />i� n� S[ tn� <br />ASSOCIATEDBUILDWGPERMIT#(ifapplicable): G/��2�y,..e��C',�,Gl� �y �'����""�-^'c"� if1S�'��=�2•S" � �i�{��+G��f���. <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Fixtu es Lisf of Fixtures Fixfures Lisi of Fixtures <br />A/C — Air Handling Units Heat Pump <br />Forced Air Systems Unit Heater <br />Gas Piping Boiler <br />Water Heater Refrigeration <br />Gas Fireplace Wood Stove <br />Gas Ranae Ductinq <br />c;iotiies uryer <br />Range Hood <br />� Exhaust Fan <br />Other: <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br /># of List of Fixtures #°f List of Fixtures <br />Fixtures Fixtures <br />Toilet Backflow Preventer (Inside Bldg) <br />Bathtub Urinal <br />1 Lavatory (Wash Basin) Drinking Fountain <br />Shower Floor Drain <br />Kitchen Sink & Disposal Grease Trap <br />Dishwasher Roof Drains <br />� Clothes Washer Medical Gas <br />Water Heater Other: <br />Sink (Service/Bar/Mop/etc.) Other: <br />SPRINKLER 1 SUPPRESSION SYSTEM � <br />Number of Heads � <br />ACKNOWLEDGEMENT.� 1 have reviewed this application and confinn 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 autliorized under any circumstance. 1 am the owner, or 1 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 />OwnerlAuthorized Agent Signature <br />City of Everett Official Use Only <br />PERMIT # <br />Y � �fI�OS—o�Z <br />ate (Revised 10/12/2015) � � <br />