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PERMIT APPLICATION <br /> BUILDING CHANICAL / PLUMBING / SIGN Ii anRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICI <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> OL (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 /> - <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �p.CGtm,B�/,1 �tSiSC�¢.c7 /,C ..�Lc TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET/�Q• /� 7 9 D <br /> CITY,. :* STATE T X ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME. �aL1L- /G.uS <br /> CONTRACTOR ADDRESS: STREET <br /> CITY G09' STATE /,//g ZIP / YQ <br /> CONTRACTOR PHONE:02 -3 . 7 33= -3X/ CONTRACTOR EMAIL: © /��rb, <br /> CONTRACTOR LICENSE#(REQUIRED):A,L ZZ W Q 774 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): S- <br /> PRIMARY CONTACT: ❑ OWNER JXCONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:a,5-_:j • <br /> �a/Yn//� �jz���c�y/l�•CL!/�/�ot2/C�s�.S CONTACT EMAIL: �+v� /�p ��y� /Gx�S• G�6 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ,L Contract Price of Work: $ l� <br /> Proposed Use of Building: 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.l. Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: q2,9�-iave E X/ST/N!r <br /> ti,05ti 'xn'o.Q �?i9 F�.��S+<! .�f F�4 c X ST i N G �S/•Lo.v �S ib N - <br /> �u D �T2cc C_7-uiC.4 z C if�.v GLS. <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 1 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#��F �✓��� <br /> Owne thorized Agen ignature Date (Revised 10/12/2015) <br /> V/ <br />