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14477 PERMIT APPLICATION <br /> BUILDIN( _ 1ECHANICAL/ PLUMBING / SIGNRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT` T nnpRFs /lye w PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivisioft Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 7-7/q , 6'atoq Q e, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET , S / <br /> CITY L.`'v r e7,4 STATE &l/? ZIP ?901 <br /> OWNER PHONE: OWNER EMAIL: �? / <br /> CONTRACTOR NAME: �in X 6xfGRi 2 C n , � <br /> CONTRACTOR ADDRESS: STREET 2?.Z�j 1�j !"G Sg i607/-'f /�c 1' /L(�Q//Z_ <br /> CITY STATE �,7„-_,),7„ ZIP qVC2, <br /> CONTRACTOR PHONE: 208 330 d 7' CONTRACTOR EMAIL: O/na((X 20/5 ,77 /1 co/77 <br /> CONTRACTOR LICENSE#(REQUIRED):Q/'nA faae S 3 PA CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas 0 Electric ❑Other <br /> Building Type: ❑SFR-Detached DSFR-Attached ❑Duplex ❑Multi-Family-#of Units: El Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition El Remodel 1gRepair ❑T.l. ❑Sign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: l,. C'CCjG-v $tcr(( (c 1524<r) <br /> / e,-)76.. te_ Sider 56?.e-s / , Z)( ood c <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn Alteration _Repair Type of Project: _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 Preventer(Inside Bldg) <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/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.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 /> aPERMIT%!4 <br /> # p7 1003 /ovl f//,` <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />