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PERMIT APPLICATION <br /> BUILDINC ECHANICAL / PLUMBING / SIGN iT'RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVIC� <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- PROPERTY TAX#: <br /> _ LU, 7 A 'Ll- <br /> LEGAL <br /> —LEGAL for new construction: Short PlatJsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: t'p �h TENANT NAME(If Commercial): G/GGt!'Gt/ GtrcSEl �''�CGS <br /> OWNER MAILING ADDRESS: STREET / 5 ,-d AAe -ff- W <br /> ciTvS�d srATE w ZIP <br /> OWNER PHONE: //�� OWNER EMAIL: 1�8y/ �° r re--s i Crl7 <br /> CONTRACTOR NAME: ��{y5p i 1 '06A-f-t S I <br /> CONTRACTOR ADDRESS: STREET ✓'�/V 5OtCl-h <br /> CITY 5 eel #-(.( STATE W 1 ZIP`/ O Z G <br /> CONTRACTOR PHONE: ZO -- c�'3Z- 12 17- CONTRACTOR EMAIL: &'Illn e ez 5t�vide-4 4 ,1,0kn <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER 4-CONTRACTOR ❑OTHER(Please Speci ) �1 <br /> CONTACT NAME: CONTACT PHON is Q&-6�jp7j <br /> CONTACT EMAIL: LL? <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: LD1'41 Sma? &4,1Y h4'1" 5e/, <br /> Contract Price of Work: $ _ <br /> Proposed Use of Building: lt'e 6A 2- 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 �.I. []Sign []Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: )-e-& 6.kY4-rjV7YI Q 5�11��le gle h0V;�, r $e' <br /> h `{Pr a / tab u� 5ir�,�-y` Gds-acs CJ/u doaY�v �SS <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&D' osal 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 lSink(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 /> ;TZ) L 1 15 <br /> l 2� � <br /> Own ut 6orize6l Agent Signature 136te (Revised 10/12/2015) <br />