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PERMIT APPLICATION <br /> BUILDINU I MECHANICAL / PLUMBING / SIGN / ,i 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 <br /> ADDRESS: PROPERTY TAX#: <br /> L' <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: i Q TENANT NAME(If Commercial): 7L <br /> OWNER MAILING ADDRESS: STREET q.S 3 �f, <br /> CITY (51,-,-1? STATE I/(/C''f� ZIP / O �V <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: r. 1 r - <br /> CONTRACTOR ADDRESS: STREET / - v <br /> Cc"// ��/� STATE i LZIP <br /> CONTRACTOR PHONE: `/��S' /�'- r' CONTRACTOR EMAIL: n -// i - X-7 <br /> CONTRACTOR LICENSE#(REQUIRED): rC7/ Jr� �� ? CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):r Z2 <br /> PRIMARY CONTACT: IZOWNER DKCONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> )"(/C C f CONTACT EMAIL: �(?_� , ?�^.. 2, <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ontract Price of Work:$� ✓(i �_ . <br /> Proposed Use of Building. r — =f r- ,Si+ 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 ❑Re air ❑T.I. PSign ❑S rinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: 7� <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 /> Fixtures List of Fixtures Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> 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 I 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.l am the owner.or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# G1('-.®. / ✓Ooz) <br /> Owner/Authoriz Agent Signature Date (Revised 10/12/2015) <br />