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PERMIT APPLICATION <br />BUILDINCi i i'viECHANICAL / PLUIIABING / SIGN / arrcINKLER / DEMOLITION <br />CITY OF EVEREI-T PERMIT SERVICES <br />3200 CEDAR STREFT, 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 />PROJE.CT SITE ADDRESS: ��; 4; (,i �f % j� /-� v e. S C, �, �'_-• <t} ��, Z�5 PROPERTY TAX #: <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFOItMAT10N <br />� <br />OWNEIR NAME: �u � t-y--r�, �,r i� S� TENANT NAME (If Commercial): <br />OWNEI� MAILING ADDRESS: sikt�r j G� � �j ��—`' �iv e, S,� � <br />ciTv �Vc�c'� srArE (,1,� �� zir� G%��U� <br />OWNEI� PHONE: y ZS -� ��__� 6� g OWNER EMAIL: <br />CONTFZACTORNAME: %'�-��,:��nble. He�:�:.+u .i- �-c..�l:�+-1 =��. <br />CONTFtACTOR ADDRESS: si�z�rr 35 /5 �j � v` ,O�-, ,5 � , <br />CITY �i k z �"f'cV c,.a STATE �;' - III' � t�j �-.� <br />CONTFiACTOR PHONE: �-(�S- 3 j H-� � po CONTRACT�R EMAIL:�I,;,�-k �_ K�.r.i.Yl.t�h�tt:r K.,.(����• �� �: <br />CONTF:ACTOR LICENSE #(REQUIRED):��-�-GY� �+T`[ ( U i4 C CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): ��1j/ �!Iv� <br />PRIMARY CONTACT: ❑ OWNER 1� CONTRACTOR ❑ OTHER (PleasE; Specify) <br />CONT��CT NAME: CONTACT P'HONE: �Z� _ � 3 y-{� y,�c <br />� Dt ��- k C� c•� �� =� c �• CONTACT E�.MAIL: <br />cl�.,ck��'':{f. --i..1.�1c h�.��;.. •..lc._.,1.`-, inc.c<a'�� <br />BUILDING PERMIT �►PPLICATION <br />Existinq Use of Building: ��5 �+�,,, �<� Contract Price of Work: $ 35 cn�� <br />Proposed Use of Building: �zS;dzhtr Heat Source: �Gas ❑Electric ❑Other <br />Buildinq Type: ❑SFR-Detached �SFR-Attached ❑Duplex ❑Multi-Family-# of Units: ❑Commercial �Industrial <br />Type of Project: ❑New ❑Addition QRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Cf�ange of Use <br />DESCF:IPTION OF WORK: <br />C�1GI.YlCj C '�' %�C [J � � -�jJ'.' V1ClL G 1 n Vl�l `�v ✓ �., ��iS • <br />l <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair T�/pe of Project: _New _Addn _Alteration _Repair <br /># of # of # of # of <br />Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of 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 Di:�hwasher Roof Drains <br />Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br />Range Hood W;ater Heater Other: <br />Exhaust Fan Sink (Service/Bar/Mop/etc.) Other: <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />ACKNOINLEDGEMENT 1 have reviewed this application and confirm the information coMained herein is true and correct. Work done pursuant to this perniit nnist coniply svrth <br />current federal, state, and local law. The granting of a permit only authorizes approved work and no deviations therefrom. Deviations must lirst be authorne�l in wribnr� (roni (hc <br />Building 0lficial before being authorized under any circwnstance. 1 am the owner, or I am authorized by the owner of this property to perform the work for wliir,h <ip��licaGon is niade. <br />and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />C��:.C�� �. � ��� <br />Ownerliauthorized Agent <br />re <br />�5'-y-2� ► W <br />Date <br />City o( Everett Olfic���l Use Only <br />PERMIT # � � <br />� �', , ; � +� �� ,� _ �-1 I �+ <br />1 <br />(Revised 5/20/2016) <br />