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PERMIT APPLICATION <br /> BUILDING , ....-CHANICAL / PLUMBING /SIGN / Sr ruNKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov l www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: C) lb lzcg— 6G;rI PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subI­•_ Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION' ,..:. .,. .... <br /> OWNER NAME: <br /> TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: sTRE,-r 10q <br /> CITY STATE - ZP LJ <br /> OWNER PHONE: 7�-- OWNER EMAIL: <br /> CONTRACTOR NAME- `<1"V) " C- 111 i" <br /> CONTRACTOR ADDRESS: STREETjL <br /> CITY �✓ .^.."ti.,.Tr... ry STATE ZIP ." ,`, ^'',{ <br /> CONTRACTOR PHONE: G <br /> ( CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIF2ED): {?ray g� Lt, p . iG<17 J ITY OF EVERETT BUSINESS LICENSE#(REQUIRED): G16 <br /> PRIMARY CONTACT: ❑OWNER C-ONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: a <br /> BUILDING PERMIT APPLICATION <br /> ExistirI2 Use of Buildin : Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: . Gas ❑Electric ❑Other <br /> Building Type: FR-Detached ❑SFR-Attached ❑Duplex []Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition []Remodel IQftepair ❑T.I. ❑Sin ❑S rinkler ❑Demolition []Change of Use <br /> DESCRIPTION OF WORK: <br /> 'P�—'4 Cc- CV1 S 'FLA -►Z rt.t=c C. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration -oRepair Type of Project: _New _Addn _Alteration Repair <br /> #of List of Fixtures #of <br /> Fixtures List of Fixtures #°f List of Fixtures #of <br /> Fixtures Fixtures Fixtures List of Fixtures <br /> A/C <br /> —Air Handling Units Heat Pump Tot let Backflow Prev eIn er(inside Bidg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavato Wash Basin) DrinkingFountain <br /> Water Heater Refrigeration Shower Floor train <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ductin Dishwasher {hoof Drains <br /> Clothes Dryer Hookups Other. Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink ServicelBar/Mop/etc.} Other <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT:l have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br /> :urrent 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 /> 3uilding Oficial before being authorized under any circumstance.I am the owner,or l am authorized by the owner of this property to perform the work for which applicalion is made, <br /> Ind I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT#/ <br /> )W» r/Authorlxed Agent Signature Date (Revised 9/24/2016) <br />