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PERMIT APPLICATIOVRINKLER <br /> BUILDIN ECHANICAL / PLUMBING I SIGN ! 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 /> PROJECT SITE ADDRESS: l 1 e- e PROPERTY TAX#: DS AZ240rD <br /> 064 11 1 1 Ah ICA 44 7 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long lugai description) <br /> / CONTACT INFORMATION <br /> OWNER NAME: �J r�'O� V1O eVeAl-C# Uf 1A TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET V►n 19OLV ev-DZ <br /> � [ 4--ev <br /> CITY STATE C� ZIP 1 l <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: ugh J�eG 6-I2cl G <br /> CONTRACTOR ADDRESS: STRFET / <br /> ciTv f(L-C STATE � ziR Li z' <br /> v <br /> CONTRACTOR PHONE: 2.5-3-liTZ- 2 I LO CONTRACTOR EMAIL: I G sl e Q ( G •C P/ <br /> CONTRACTOR LICENSE#(REQUIRED): S t Gf N T'F LQ?j91 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):(?3 Z. <br /> PRIMARY CONTACT: ❑OWNER &CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ? ' - 2 Z / <br /> CONTACT EMAIL: ee e-nZ <br /> i G <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building g AAv�k-AnContract Price of Work: $ <br /> Proposed Use of Building: i'4, Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Protect: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. WSign ❑Sprinkler ❑Demolition []Change of Use <br /> DESCRIPTION OF WORK: `I r I l <br /> �l � fV1g a FIuS� N^wµ{ � C � G-"�'I Lt4eA/ -5t-4- -fes CvS� <br /> «. u��41;�s V 'e -�a 'eHCl5 �Ii,-5 (�cwwev . <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 #of List of Fixtures <br /> Fixtures 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 /> ACKNOWLEDGEMENT.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 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 I 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 /> City of Everett Official Use Only <br /> PERMIT# ( <br /> Owner/Authorized Agent Signature Dat (Revised 10/12/2015) "� <br />