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PERMIT APPLICATION <br />BUILDIN�ECHANICAL / PLUMBING / SIG�RINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVIC � <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 />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: �`'�QZ SF tVEQETC N�AU.�VA� PROPERTY TAX #: <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: Sj'�O t'/�S S' CQ(1'1Qpn/� �S. TENANT NAME (If Commercial): (,�$ <br />OWNER MAILING ADDRESS: srReeT J��2 S� � � N� <br />CITY �CR,� STATE ��' ZIP �2OQ <br />OWNER PHONE: ZS.3• SZ� •',��%%S OWNER EMAIL: GG %(F.{'1� Ci,s�'�qp�-�c�S7 GQ, CQ..� <br />CONTRACTOR NAME; <br />, <br />CONTRACTOR ADDRESS: sTrzeeT <br />CITY STATE ZIP <br />CONTRACTOR PHONE: CONTRACTOR EMAIL: ,,� <br />CONTRACTOR LICENSE #(REQUIRED): CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR � OTHER (Please Specify) I�e-�nrr FbR T'c�vr�w- <br />CONTACT NAME: CONTACT PHONE: CJSZ,��,�jQ�(,Q <br />T'� �n S�yE�� CONTACT EMAIL: � J mS @ e� �rJ Qnes . C.�/��. <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: '�'lCl.k�/ri C.C; Contract Price of Work: $ � 5� 0� � w <br />Proposed Use of Building: �1'LCA�-�'( C,(;� Heat Source: ❑Gas ❑Electric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑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: �2C�maf��.. Q,� E�CL td-(�((r R�� /�tC. �'�,'ti./�' s�'� ar LK Tl� E/il�QlS. �(yl,�Qof <br />�(�lJ /�) A VR 6 c G S Sav�t.�' <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLiCAT10N IV �. <br />Type of Project: _New _ Addn _Alteration _Repair J Type of Project: _New _Addn _Alteration _Repair <br /># of ��st of Fixtures #�� List of Fixtures #�f 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 />SPRINNKLER / 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 befo�e being authorized under any circumstance. I 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 />City of Everett Official Use Only <br />PERMIT <br />.� �- 6����« b - D IZ <br />Owner/Authorized Agent Signature Date (Revised 5 0/2016) �.� <br />