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PERMIT APPLICATION <br /> BUILDING; I MECHANICAL 1 PLUM13ING I SIGN I SPRINKLER I DEMOLITION <br /> CITY OF E=VERIMTT PERMiT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-5510 I FAX 425-257-$857 1(E)everettepsQaverettwa.gov I www.everettwa.gov/permits <br /> Slue olr Black Ink Only Please PROJECT SITE INFORMATION <br /> PROJECT SITZ*ADDRESS: CI I![1 _ PROPERTY TAX : DU k <br /> LEGAL for rim construction: Short Plet/subdivision Lot No.. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STFEer O/ Q <br /> Oily V `Uw tr- STATE ZIP <br /> OWNER(PHONE: J r �� + OWNER EMAIL <br /> CONTRACTOR NAME: {/lJtlsl ��tJ1rT�Ll�`) j�}' GT� <br /> GONTR ACTOR ADDRESS: STREET j 1 (/ — G)X yy <br /> f Grry t STATE !? ZIP <br /> CONTRACTOR PHONE, ' CONTRACTOR EMAIL. ) �/��(�� aym <br /> CONTRACTOR LICENSE#(REQUIRED); lw}� �6� CITY OF EVERETT BUSINESS LICENSE;#(REQUIRED): [� <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CON AACC r NAME- CONTACT PHONP: <br /> CONTACT EMAIL: �UPI <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Buildin Contract Price of Work:S <br /> Proposod Use of Building; Heat Source: ❑Gas ❑Electric F70ther <br /> Building T e: ❑SFR-Detached ❑SFR-Attached []Duplex ❑Multi-Famil Vfiof Units: ❑commercial ©Indus! <br /> Type of Project ❑Neva C�Addition ❑Remodel ❑Repair ❑T.I. ©Sign ❑S rinkler ❑D$rnolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: <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 #of # <br /> f7xtures List of Fixtures Fixtures List of Fixtures #of of List of Fixtures List of Fixtures <br /> J=fxtLtres <br /> A/C—Air Handlin Units Heat Pumf�lxturea p Toilet BackflpW Freventer Inslde BEdg) <br /> Forced Air Sysfsms Unit Heater Bathtub Urinal <br /> Gas Pip62 Boiler Lavatory(Wash Satin) Drinking Fountain <br /> Water Heater, Refr3 erafion Shower Floor drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Greasa Tie <br /> Gab Range Ducting Dishwasher Roof Drains <br /> Cipthes Dryer Hookups Other: Clothes bV�eher Medical Gas <br /> Ran e Hood Nater Heater Other. <br /> Exhaust Fan Sink(Servioe/Bartmopletc. Other: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT.,i have reviewed this appilc*tion and confirm the info,•matiorl contained hereln is true and correct. Work done pursuant to this parmft must comply with <br /> ourrent fader*!,state,and tocaf law.The granting of a permit only authat1z35 approved work olid no deviations therefrom.DeviaRons must first be authorized to uniting from the <br /> Buildlog Official before being aurhofizgd under any Circumstance,i am the owner,orf am authorized by the owner of this property to perfprm th9 work for which sppficahon is made, <br /> erd I comply with the State Contractors Law 18 27,4CW and 296,200A WAC. <br /> City orDvort!t Cfcie!Use pnty <br /> PERM T# <br /> vv� CC <br /> 0yg11pY/Authorized Agent Signature Date (,Revised 5/2012016) <br /> 1 <br />