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'-__ __ <br />� PE MIT A P F�ATIOI� <br />BUILDIN MECHANICA PLUMBIN / SIGN / SPRINKLER / DEMOLITION <br />CITY F EVERET RMIT SERVICES <br />3200 CEDA EET, 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 />PROJECTSITEADDRESS: f�-�� `�� ��� PROPERTYTAX#: ��a�1;� -�3�_�C�ZZ�ze � <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNEIR NAME: (V� � C����e � � � G:�� j N �^ TENANT NAME (If Commerciall: <br />7 <br />OWNEIR MAILING ADDRESS: sTREET 1 SI C� <br />CITY �L� ���C�"[ I <br />OWNEIR PHONE: Ll �S"�5 �' �I �i% � <br />CONTFZACTOR NAME <br />CONTFtACTOR ADDRESS: <br />�' C i._��' S �. �.�� .5'� i��t <br />STREET � y ( <br />c m G--' � r(r l. T t <br />l"' <br />CONTFtACTOR PHONE: Z �� ` ,3 5 .�- � ) �:, <br />CONTFtACTOR LICENSE #(REQUIRED): �v� [�V y.,( � � <br />PRIMARY CONTACT: �OWNER ❑ CONTRACTOR <br />CONT��CT NAME: <br />J�,-i � E� T�° c��� � tr <br />C Lt C' lCr'/' :'' f �`G <br />OWNER EMAIL: <br />I L�'1 � t° f 11' <br />��� ��. �� <br />STATE V"�,7 � ZIP �, � � V <br />t��i.]�-��j�►"� �'�-�T�'htti �. t'�'Y''1 <br />4�i y �L�.� <br />STATE <br />ZIP <br />CONTRACTOR EMAIL: ]� ��7� L'e(,, y5 —' f�, f i'i,,C� s u� � L <br />� L� L' �� CITY OF EVERETT BUSINESS LICENSE #�REQUIREDj: �� <br />❑ OTHER (Please Specify) <br />CONTACT PHONE: L��S = 71� �: �- ��; �;C' <br />CONTACT EMAIL: �1nc '' C'C''�' 'rl'S �- /1't c",, l, G�%�'�+ <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: S i iic�l "�`` °�'� � � �'�i L'�'Yi ' Contract Price of Work: $ .� C(.�t <br />Proposed Use of Building: , i n� �� f��'=w+ 1 {t�%i�� Heat Source: Gas ❑Electric ❑Other <br />E3uildinc3 Type: I�SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: ❑Commercial ❑Industrial <br />Type o1 Project: ❑New ❑Addition L�,Remodel ❑Repair ❑T.i. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCF�IPTION OF WORK: �� ��1tiL•�� W,�� �� ��y��, C' (G$� tj bt�'}r,c;�'ti�l i'-J�iS� hc. �`C(e. �'OL'IY! G-Y� IJ�ci/'i:i'�bt � <br />-�-�.- -, � ���—�i+�-3�tt•�}�_ek��f`ivi:r GuC�(� il� n�u: �c�'�Z(' �`�C, ��.v�x�.T.�h;#�✓+ri °,�'cf� �i►►U <br />,���,ti� c=�-{`��� tf+l�t�'_E� `�'�� rir,,<, ��;5 -{-i ���t�c�P. 4�!:� ri�.iutc' u..indC��sJ '-tv 1.��'-}i- Gx �'i'i�'� <br />�t:c?6 bc �4s�e"j1 i.k.l$�1iK<' w,�-Y�i'rlt: �1a.� -�('iLVII+J'l. t'�t,�;,5: 1���St<�"� (��'i' Si/lk ih iC_'�'-� �,.�ek�s'�''i <br />ASSOCI�TEDBUILDINGPERMIT#�(ifapplicable): j�;����-ih ���� -�;��� ��D}tY,<),�•c�1i.:��,h��-,`iuf�f ���►'1�S i'�4�Cd��� <br />MEGHANICAL PERMIT APPLICATION <br />Type o oject: y� New _ Addn _Alteration R�pair <br />Fixtu es List of Fixtures Fixtures List of Fixtures <br />A/C - Air ndling Units Heat Pump <br />Forced Air Sys s Unit Heater <br />/ Gas Piping Boiler <br />Water Heater '� Refrigeration <br />Gas Fireplac � / Wood Stove <br />Gas Rar�g� Ducting <br />Cloth�s Dryer Hookups Other: <br />3nge Hood <br />Exhaust Fan <br />SPRINKLER / SUPPRESSIC)N SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />Type of Project: �/New _Addn _Alteration _Repair <br /># of List of Fixtures # of List of Fixtures <br />Fixtures Fixtures <br />Toilet Backflow Preventer (Inside <br />Bathtub Urinal <br />Lavatory (Wash Basin) Drinking Fountain <br />Shower Floor Drain <br />Kitchen Sink & Disposal Grease Trap <br />Dishwasher Roof Drains <br />Clothes Washer Medical Gas <br />Water Heater Other: <br />/ Sink (Service/Bar/Mop/etc.) Other: <br />�CKNO�NLEDGEMENT: I have reviewed this application and confirm Ihe mformation cvntained herein is true and co��ect. Work done pursuant to this permit must comply with <br />current federal, state, and local law. The granting of a permit only authnrize: appmved N�ork and no deviatiors therefrom. Deviations must first be authorized in w�iting from the <br />Building Official before being authorized under any circumstance. 1 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 />�/1 i�'f <br />Ownerh4uthori <br />Signature <br />5-/3i//G� <br />Date <br />� <br />City of Everett O(ficial Use Only <br />PERMIT # �n � <br />f-, <br />�i <br />(Revised 10/12/2015) e <br />� � <br />