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--�-.`�PERMIT APPLICATIO� <br />BUILDIN� MECHANICA'L / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />� �--Gf-�'iOF 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 />(Bt�te or Black Ink Only Please) PROJECT SITE INFQRMATION <br />PROJECT SITE ADDRESS: J �% �• �� � � � �^� � ,-� PROPERTY TAX #: �'� � �j� � (�`� (p i.'� �Gr,,t. ��` � <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTA�CT INFORMATION <br />OWNER NAME: ��� �' ��_; � � C.L �C� t' % TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: srREeT �TZLC(� ^ U"C,. <br />� � � <br />CITY ' v(� � STATE �/� ZIP � <br />OWNER PHONE: y ,J�' % ^ � j`Q ` �'' OWNER EMAIL: � � ' ('<=(�/ .S "� Z�Li�t,l (• �' p//l� <br />CONTRACTOR NAME: � �_ , ��?L �„� � � • <br />CONTRACTOR ADDRESS: sraEEr — % 21{ +�'b `'� I� <br />� SIATF ZIP �� L <br />cn,� " �. �L�c.. n c� � :� <br />CONTRACTOR PHONE: ���' �,'i2% �� ° �3 CONTRACTOR EMAIL: ; •� 4�' /�I;' ' v • (.'��� <br />CONTRACTOR LICENSE #(REQUIRED): �,(./`Gt�•`j� > l�. CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): ' �1 � F; �i <br />PRIMARY CONTACT: OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: ��5--7 5�� -1 �, �;� <br />M� �. ..� C` ��� E jr CONTACT EMAIL: /l.i ����� ���-' �,rs c,�, c: i�i1 C� l I•�' Ci� <br />BUIL.DING PERMIT APPLICATION <br />Existing Use of Building: �� �� �c:� � Contract Price of Work: $ fj �i��i"` <br />< <br />Proposed Use of Building: , C p� Heat Source: Gas ❑Electric ❑Other <br />Building Type: FR-Detached ❑SFR-Attach � ❑Duplex ❑Multi-Family-# of Units: ❑Commercial ❑Industrial <br />Type of Project: ❑New ❑Addition emodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />� <br />�/� �. <<� �-�� �e �� ��� P E� F� r�.� I cc't?X M v� z�C �f �f d� f� St �: -�h �,;C�CT ��' ��e rNcc�-� �� <br />r� C r�vt�., �k � ��� <,��,5 L-i � �f c� ��}�i L '�'u.r�i2�?c-�-, � n� �: ��'`� -�i �"e�lcc�r� . <br />ASSOCIATED BUILDING PERMIT #(if�pplicable): b�9 �— Gt� <br />MECHANICAL PERMIT APPLICATiON P�UMBING PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /># of List of Fixtures #�f List of Fixtures # of List of Fixtures #°f List of Fixtures <br />Fixtures Fixtures Fixtures Fixtures <br />A/C — Air Handlin Units Heat Pump Toilet Backflow Preventer Inside Bld <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/BarlMop/etc.) Other: <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />AGKNOWLEDGEMENT: I have reviewed this application and r,on(irm the in(nrmahon confained herein is true and correct. Work done pursuant to this permit must comply wifh <br />current federal, state, and local law. The granting of a permit onty authorizes approved work and no deviations therefro,�n. Deviations must first be authorized in writing irom the <br />F3uilding Official before being authorized under any circumstance. I am the owner, or I am authorized by the owner ol this property to perform the work for which application is rr,ade, <br />and I comply with the State Contractors Law 18.27 RCW and '296.200A WAC. <br />City of Everett Official Use Only <br />PERMI <br />(Revise 5/20/2016) � <br />z <br />