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PERMIT APPLICATION <br /> til - .- BUILDINu i MECHANICAL/ PLUMBING /SIGN iir---RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 l(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS / ,( CSOA PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision / 4, Lot No. (attach copy of long legal description) <br /> : : . :,CONTACTINFORMATION <br /> OWNER NAME: J(J0i/1/ 'f" LCg t'( .�GZ.4 WNANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Pg # S if <br /> , /� *2 ,g 7' � T�?'-" <br /> CONTRACTOR A�D/D�RESS: 1 L 4' /`� (la, $'- et 3/� ✓( <br /> �I&i E. CITY p,/� / A.4STATE /����ZIP <br /> CONTRACTOR PHONE: et a'9" ! 9 O iONTRACCTrOR EMAIL:_ 40664.#,(ef/.S J "'SX,�i�i1" <br /> CONTRACTOR LICENSE#(REQUIRED): i 2.49C/(D7I e Y CITY OF EVERETT BU ESS LICENSE#(REQUIRED):053315 <br /> PRIMARY CONTACT: ❑OWNER "CONTRACTOR 0 OTHER(Please Specify) <br /> CO TACT NAME: / CONTACT PHONE: �Le - 14'CJ C� <br /> (J4/ �7� 1-/-o (f X57 CONTACT EMAIL: <br /> _ _ _ = BUILDING PERMIT APPLICATION - <br /> S i- d'36/l Q CO. ""'k <br /> Existing Use of Building: Y f, Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial CI Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel ;:IFZepair ❑T.I. ❑Sign ❑Sprinkler /❑Demolition ❑Change of Use <br /> Dhet. C O N(14,'41-;.t.,/ <br /> OF Q'��! r'`. / r1:74 <br /> - ' � �d Ise.s.., G✓f"ivigOa ,f f 6 )1)71.,'' <br /> F126961c (dee*, pet.- (L5 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> PLUMBING PE:RMITAPPLICATION. <br /> :MECHANICAL PER..MIT APPLICATION;: ;; <br /> Type of Project: New _ Addn Alteration _Repair Type of Project: _New _Addn _Alteration Repair <br /> #of #of #of List of Fixtures <br /> List of Fixtures #of List of Fixtures List of Fixtures Fixtures <br /> Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump I Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater I Bathtub Urinal <br /> Gas Piping Boiler I 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 i1 Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: I Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER:I 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 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 wi the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only <br /> ! O [ �p PERMIT#;� ' O� \ <br /> A e�Si nature Date (Revised 10/11x21',2015) o \ <br /> ner/A horize g 9 <br />