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PERMIT APPLICATIOt, <br /> BUILDING ECHANICAL / PLUMBING / SIGN RINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OL 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: [ /' Icy, ` / P ERTY TAX#: <br /> Jr fi <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ;/C TENANT NAME(If Commercial):P F14 b <br /> OWNER MAILING ADDRESS: STREETi - rn� <br /> CITY &Vert-( <br /> OWNER PHONE: L4-,t-16 -227 -Z27s 1OWNER EMAIL: <br /> CONTRACTOR NAME: CI✓I 5 )f°L ?fl' cao / <br /> CONTRACTOR ADDRESS: STREET 33 70 IJ,s-7 ut(la &VV , <br /> C'Ty n h 46661 <br /> CONTRACTOR PHONE: 2-5-3. �2SZ- I q6 CONTRACTOR EMAIL: ���� G,'n fti s .(-C,41 <br /> CONTRACTOR LICENSE#(REQUIRED): �inl �� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):�J :� <br /> PRIMARY CONTACT: ❑ OWNER 5FCONTRACTOR ❑ 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: V 1 kv 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 E�Sprinkler ❑Demolition []Change of Use r <br /> DESCRIPTION OF WORK: �lelre� <br /> nw ��liK - <br /> J I J° S�evL r1"1;Iyer- ���thr� <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:/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 /> / PERMIT# r <br /> Owner thorized Agent Signature Date (Revised 10/12/2015) <br />