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PERMIT APPLICATION <br /> BUILDING-MECHANICAL / PLUMBING / SIGN �RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVIG� <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: Lc�`Z Y 4Aw' O 4UJ.- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ^A /c. CONTACT INFORMATION <br /> A4 <br /> OWNER NAME: C11 Jc�r c <br /> -Fty t ( S c TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1 <br /> CITY .�� STATE W /-f ZIP 2,5 (-) <br /> OWNER PHONE: OWNER EMAIL: //LJcLit� : v S�u��<<4 S'• °-� >�3a��'t <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: [1 OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT <br /> qq NAME: j CONTACT PHONE: <br /> V�lci 5—� [t✓lccGcc�S?v� CONTACTEMAIL: Q�6irc<J,�•Suola4dt % <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ � L-c <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached []Duplex -12 IUltl-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: El New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition []Change of Use <br /> DESCRIPTION OF WORK: <br /> '��1� `� lel� l� <br /> `.' tt��^ l/ � <br /> ' <br /> ASSOCIATED BUILDING PERMIT#(if applicable): W k 0J <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of #of #of #of <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures List of Fixtures <br /> 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: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 /> 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 Cant r ors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Ow er/Authoz Agen ignature Date (Revised 5/20/2016) <br />