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PERMIT APPLICATION <br />BUILDIN d I MECHANICAL / PLUMBING / SIGN P 61 i21NKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />P'10'? T v E DDR oad <br />PROPERTY TAX #: 9a NWC) G 06 <br />LEGAL for new construction: Short Plat/division Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: �5jc� M TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET/, <br />CITY ,G /�L�'G STATE (V/I /� <br />ZIP 7B201 <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR NAME: 6+ c fV� �C' S�Q►a�l iC'�-mil <br />CONTRACTOR ADDRESS: STREET F0 � �j <br />1 , t W^ n• <br />CITY .\� U STATE Ld R ZIP y <br />CONTRACTOR PHONE: JY96 S-43 3, 1 ?->oI <br />CONTRACTOR EMAIL: ORJC t� CD ��CC�vC� ' �L�C22'.44Cli� <br />CONTRACTOR LICENSE #(REQUIRED): w- V ' 1 l) 5- <br />F— I ^ <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): o JC, <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR 21 OTHER (Please Specify) 14-,4)kGGZ4 <br />CONTACT NAME/:. <br />1 K `1 6�`7i'1-12 <br />CONTACT PHONE: CJ (p%jyB <br />CONTACT EMAIL: <br />BUILDING PERMIT APPLICATION <br />. <br />Existing Use of Building: "41L47 1/O9 <br />Contract Price of Work: $ <br />Proposed Use of Building: <br />Heat Source: ❑Gas ❑Electric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi -Family-# of Units: INCommercial ❑Industrial <br />Type of Project: ❑New ❑Addition rlRemodel ❑Repair ❑T.I. []Sign []Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />/,'I /90/' 41112 0.( -74,t4 <br />117& <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: New _ Addn _Alteration _Repair <br />Type of Project: _New _Addn _Alteration _Repair <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br />A/C - Air Handling Units <br />Heat Pump <br />Toilet <br />Backflow Preventer (Inside Bldg) <br />Forced Air Systems <br />Unit Heater <br />Bathtub <br />Urinal <br />Gas Piping <br />Boiler <br />Lavatory (Wash Basin) <br />Drinking Fountain <br />Water Heater <br />Refrigeration <br />Shower <br />Floor Drain <br />Gas Fireplace <br />Wood Stove <br />Kitchen Sink & Disposal <br />Grease Trap <br />Gas Range <br />Ducting <br />Dishwasher <br />Roof Drains <br />Clothes Dryer Hookups <br />Other: <br />Clothes Washer <br />Medical Gas <br />Range Hood <br />Water Heater <br />Other: <br />Exhaust Fan <br />Sink (Service/Bar/Mop/etc.) <br />Other: <br />SPRINKLER <br />/ SUPPRESSION <br />SYSTEM <br />Number of Heads <br />ACKNOWLEDGEMENT I 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 / am authorized by the owner of this property to perform the work for which application is made, <br />and / comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />Signature <br />Date <br />City of Everett Official Use Only <br />PERMIT# <br />(Revised 10/12/2015) <br />