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PERMIT APPLICATION <br /> BUILDING— IECHANICAL / PLUMBING / SIGN JRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <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 /> PROJECT SITE ADDRESS: 01�Co PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME; �,4�/1,(,�y ( �/ Qu (!JVTI <br /> CONTRACTOR ADDRESS: STREET (} Ao 11214 <br /> CITY � STATE ZIP <br /> CONTRACTOR PHONE:1 ,U;3( . ti-g I CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): (,lj CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): C <br /> PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR e,12-6THER(Please Specify) <br /> CONTACT NAME: Cj�yv� SaY\—, CONTACT PHONE: 3( jo,V-3I -2-26k- <br /> CONTACT EMAIL: 1A (-p-wt)ac k(vim <br /> •b i �- <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Wki Contract Price of Work: $ <br /> Proposed Use of Building: UIAJd— Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign []Sprinkler El Demolition []Change of Use <br /> DESCRIPTION OF WORK: , <br /> i:Tbvl -�1 oar �'N "d <br /> 1Z"To RLWOKC r`e-D r?4wc id - awe , ( adc( a !- <br /> ASSOPP 4-0 1a vJa h cru-- GA-e K h <br /> CIATED BUILDING PERMIT#(if applicable): OvU 3 i vl+-ern 0J, i3O kdoLoc I X4 ck S wta..>s l <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 I 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 t 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 /> caner/Authoriz Age ignature ate (Revised 10/12/2015) <br />