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PERMIT APPL=SIGN <br /> off'� F/ootz <br /> BUILDINC ECHANICAL / PLUMBING 'RINKLER / DEMOLITION <br /> CITY OF EVERETT PERMs <br /> 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 ADDRESS _ V S C PROPERTY TAX#: �7 <br /> LEGAL for new construction: Short Plat subdivision �14 G� Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ENANT NAME (if Comm�Gefrrciall):: O L{/"f �OQ // <br /> OWNER MAILING ADDRESS: STREET 10-loo A/ Sr-ed G��j <br /> CITY �� Y!V l STATE ZIP /0 <br /> OwtiJPHONE: 3_ OWNER EMAIL: <br /> CONTRACTOR NAME e5l6) <br /> CONTRACTOR ADDRESS: STREET 3�:g I k) PS-0 <br /> CITY e l ck- STATE WA zip 9 33 <br /> CONTRACTOR PHONE 5M 78 — SW-9 0X31'$(7) CONTRACTOR EMAIL:ahqebai esov.CQm <br /> CONTRACTOR LICENSE#(REQUIRED): (� 90 LP CITY OF EVERETT BUSINESS LICENSE EQUIRED):Dc�3a0� <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ct r as-1 8o <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Reln:L F�` Contract Price of Work: $ ��•� <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type. ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-F iily-#of Units: ommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel El Repair ❑T.I. Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: S&LL 3 L&-Q ;1lam�t�,� d ItJA,GC S�tgn s <br /> ,ars,h e ss <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 Fixtur List of Fixtures Fixtures List of Fixtures Fixtures List of F' ures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow venter(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urin <br /> Gas Piping Boiler Lavatory(Wash Basin) 07inking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink& Disposal Grease Trap <br /> Gas Ran Ducting Dishwasher Roof Drains <br /> Cloth Dryer Hookups Other: Clothes Washer Medical Gas <br /> R ge Hood Water Heater,,-" Other: <br /> xhaust Fan I Sink(Ser e/Bar/Mop/etc.) Other: <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT.I 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 l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Owner/Au ori ed Agent ignature Date (Revised 10/1212015) <br />