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PERMIT APPLICATION <br />BUILDING�MECHANICAL / PLUMBING / SIGN / S RINKLER / 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 />PROJECT SITE INFORMATION <br />���JC� S�C. eIPQY�-i� �Vl l�`��. ��'.q PROPERTY TAX #: �2" �� 'I �` (. L`t ����� LL <br />for new construction: Short PlaUsubdivisio <br />No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: :��,vc'y7r-i;�C " �•��'�,� ��1�i,11, �;�;j ,�� O�i.TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTReeT � ��y�r,;,t�.�n;���?�p - ;; }�L ' »�' G� , <br />aTv � �-� 1'l', '1� C' srnre � ziP �'! � l �� <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTOR NAME, " � � � � - ` • � ;�� • <br />CONTRACTOR ADDRESS: srReer � ���^ ��� � <br />cm ���'�� srarE ' zia "l �, 1 U�.. <br />CONTRACTOR PHONE: "-1 � -1 l' — �� CONTRACTOR EMAIL: L -� �_�;`,���11'1 � � L,�\ . .�_ � �'�'� <br />CONTRACTOR LICENSE #(REQUIRED): ��C '� `,`��� J, CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): ��'�'f �j <br />PRIMARY CONTACT: O OWNER �1� CONTRACTOR O OTHER (Please Specify) <br />CONTACT NAME: ,(����� ��j�U;�Y��� CONTACT PHONE: `�uLSil,� — ��'l `-I L <br />CONTACTEMAIL: `��'����'�-�,•`-��� ���, <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: Z� �-�, Contract Price of Work: $\l;` i I l. L <br />Proposed Use of Buildin : Heat Source: O Gas O Electric O Other <br />Building Type: O SFR-Detached O SFR-Attached O Duplex O Multi-Family-# of Units: O Commercial O Industrial <br />Type of Project: O New O Addition O Remodel O Repair O T.I. O Sign Lq Sprinkler O Demolition O Change of Use <br />DESCRIPTIONOFWORK: ;y�,�-�Jti�� �;1 i�� �a,\ �IU„� ��-� C�ei'Y�iCC1� fi�-l' ��j1�i"155��:r11 ��SttrY� "[�; <br />�'_-C1�'1� Y1�t;C�� � i' iY1��i'�u� '�l.-t-UL-�-� (aV1C\ ���,(, TCj'} 5CG1i'l�i�l'�1_i <br />ASSOCIATED BUILDING PERMIT # (if applicable : <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: New Addn Alteration Repair Type of Project: New Addn Alteration Repair <br /># of List of Fixtures # of List of Fixtures # of List of Fixtures #°f List of Fixtures <br />Fiutures Fixtures Fixtures Fixtures <br />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 / SUPPRESSION SYSTEM <br />� Number of Heads <br />ACKNOWLEDG�MENT: 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 local law. The granting o( 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 the owner, or 1 am authorized by the owner of this property to perform the work for which application is made, <br />and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />rized Agent Signature <br />�%�� �''� �1 � � Lt' <br />Date <br />City of Everett Official Use Only <br />PERMIT # � <br />� �(/,��VI� <br />(Revised 10/12/2015) � <br />�� <br />