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&a <br />BUILDING " CFIANICAL / PLUMBING / SIGN / r"ZINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICE-=- <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 />PRO�ECT SITE ADP E S� ' <br />PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: C +^ f/,�/(7� LG{ � '�^ TENANT NAME (If Commercial): a' ' _ ("'A/ <br />OWNER MAILING ADDRESS: STREET <br />CITY /jV -L/STATE ZIP <br />OWNER PHONE: <br />/ �cE <br />OWNER EMAIL: <br />/`__ <br />CONTRACTOR NAME: 41t) ! /! � <br />CONTRACTOR ADDRESS: STREET <br />� <br />CITY / �jT STATE ZIP <br />,d <br />CONTRACTOR PHONE: !z� ��'}'� �✓� <br />CONTRACTOR EMAIL: �4� ,/j? �G�►�� i! <br />CONTRACTOR LICENSE #(REQUIRED): T J �,(�' r <br />,tom J <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): V(f� <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />CONTACT PHONE: <br />CONTACT EMAIL: <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: <br />Contract Price of Work: $ —'7 <br />Proposed Use of Building: L�f'�! y✓ - <br />Heat Source: _5Gas []Electric ❑Other <br />Building Type: ❑SFR-Detac'ned ❑SFR-Attached ❑Duplex []Multi -Family-# of Units: ❑Commercial ❑Industrial <br />Type of Project: ❑New ❑Adddiition ❑Remodel ❑Repair 1. ❑Sign []Sprinkler ❑Demolition ❑Change of Use <br />ESCRIPn J/!OF Y119RIK: <br />DESCRIPTION/ <br />/y/`.�s� <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: ____New _ _ Addn _Alteration Repair <br />Type of Project: _New _ Addn _Alteration Repair <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br />A/C — Air Handling Units <br />Heat Pump <br />Toilet <br />Backflow Preventer (Inside Bldg) <br />Forced Air Systems <br />Unit Heater <br />Bathtub <br />Urinal <br />Gas Piping <br />Boiler <br />Lavatory (Wash Basin) <br />Drinking Fountain <br />Water Heater <br />1 Refrigeration <br />Shower <br />Floor Drain <br />Gas Fireplace <br />Wood Stove <br />Kitchen Sink & Disposal <br />Grease Trap <br />Gas Range <br />Ducting <br />Dishwasher <br />Roof Drains <br />Clothes Dryer Hookups <br />Other: <br />Clothes Washer <br />Medical Gas <br />Range Hood <br />Water Heater <br />Other: <br />Exhaust Fan <br />Sink (Service/Bar/Mop/etc.) <br />Other: <br />SPRINKLER <br />/ SUPPRESSION <br />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 />1/:�- <br />