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PERMIT APPLICATION <br /> BUILDING I MECHANICAL/ PLUMBING / SIGN / SPRINKLER/ 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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: l 0�0 0 P v) RpI 59VI M PROPERTY TAX#: <br /> IF <br /> LEGAL for new construction. Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �(. 5� G✓1G TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STA FE ZIP <br /> OWNER PHONE: / ,, /OWNER EMAIL: <br /> CONTRACTOR NAME: P�� I f it 516N C010i4,r,ll r <br /> CONTRACTOR ADDRESS: STREET � 2�S I✓ -4 t N <br /> CITY o S FA�L� STATE Y_ ZIP <br /> CONTRACTOR PHONE: 2,d'6 — Z i Z-076 p 1CONTRACTOR EMAIL: �'�e Za yt l0Y►A/I t (�/� , <br /> CONTRACTOR LICENSE#(REQUIRED): 'A llo,sc ImCITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 3 U <br /> PRIMARY CONTACT: ❑ OWNER ONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: ( _ d CONTACT PHONE: Le <br /> ✓L Z�WI��nL(N CONTACT EMAIL: vQZ <br /> n (O"4k( /) Or .coin <br /> BUILDING PERMIT APPLICATION r <br /> Existing Use of Building: Contract Price of Work: $ Z J o . 00 <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: ew ❑Addition ❑Remodel ❑Repair ❑T.I. gn ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: le f �N� EL <br /> 195-OLL OWC SlilI OU ILLIAwfIWAO Vot, 3)6d - \&�/Fr'1Pl�C�I <br /> oitot w-C F X15oi6 <br /> A K <br /> ASSOCIATED BUILDING PERMIT#(if applicable): �\04k, <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 la . 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 aut, Hied under any circumstance l am the owner.or l am authorized by the owner of this property to perform the work for which application is made. <br /> and I comply with the State Con ctorsaw 18.27 RCW and 296.200A WAC <br /> City of Everett Official Use Only <br /> PERMIT# - <br /> ii" ii / 7�1 ,1 I lvoltk-c <br /> Owner/Authorized Agent ignatu a Date (Revised 5/20/2016) <br /> n <br />