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PERMIT APPLICATION <br /> BUILDING I ECHANICAL/ PLUMBING / SIGN / &INKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> ELS 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 /> PROJECT SITE ADDRESS: i �l�ly C PROPERTY TAX#: Oo 01- 3 <br /> J15 <br /> LEGAL for new construction: Short Plat/subdivision / Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: L TENANT NAME(If Commercial): <br /> / y <br /> OWNER MAILING ADDRESS: STREET C q VlalI( �G✓t <br /> yy <br /> CITV Q n C,ka C", h'e,G\ STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: (,-t7- <br /> r <br /> CONTRACTOR ADDRESS: STREET <br /> CITY \ STATE ZIP <br /> CONTRACTOR PHONE: — — —Z CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CjG /. CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER —,E]CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: i CONTACT PHONE: C�DIL — G - W q <br /> CONTACT EMAIL: f L� � GJL�(�r -COv✓1 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ <br /> Proposed Use of Building: ,-aVVt Heat Source: []Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: 10commercial ❑Industrial <br /> Type of Project: Mew ❑Addition ❑Remodel []Repair ❑T.I. ❑Sin ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 1 A-" <br /> Vj/ <br /> ASSOCIATED BUILDINC PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: 4New _ Addn _Alteration _Repair Type of Pr94ect: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow P.reventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower IFloor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal 11arqase Trap <br /> Gas Range Ducting Dishwasher lRoof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer, Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT.I 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.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 /> City of Everett Official Use Only <br /> PERMIT <br /> vine uthorized Agent Signature at (Revised 10/12/2015) <br /> (ft-�0f ��2 <br />