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F PERMIT APPLICATION <br /> >3UILC I MECHANICAL I PLUMBING I Sly SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SEE S <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> cls➢n6s.®efly l�l� sem) . P.ROJECT SITE 9h�lfr®�l�/f��l9i�aiP9®I� <br /> PROJECT SITE ADDRESS: Cil✓I S f jel j+ VU/� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORiNiATION <br /> OWNER NAME ( 2(�✓ Gi'O "S <br /> <onTENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET �2 I S ✓� n 5f <br /> CIN Z tlelef STATE V4 Zip 9 /J� <br /> OWNER PHONE: OWNER EMAiL: R J0 V, S M �U .e('iC U. <br /> CONTRACTOR NAME; <br /> CONTRACTOR ADDRESS: STREET <br /> CiTY STATE ,,,n ZIP <br /> CONTRACTOR PHONE: V 'Z 11 CONTRACTOR EMAIL: rJ tCLU� A-0 <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(RE IRED% <br /> PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING.PERMIT:APPL:LCATION <br /> Existing Use of Building: es-oQP-4 e— I Contract Price of Work:$ <br /> Proposed Use of Building: 13G 5)&r-e4 Heat Source: XGas Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR Attached ❑Duplex []Multi-Family-#of Units: []Commercial ❑Industrial <br /> Type of Project: ❑New ddition ❑Remodel @Repair ❑T.I. ❑Sign ❑Sprinkler ElDemolition []Change of Use <br /> DESCRIPTION OF WORK: ��/ 'X 3a , ,;� s�c"r� "Ate"" /' <br /> 9"?.�qe- w/ /.rVr lj s L)e- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL.PERMITAPPLICATION 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 /> J 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 /> j Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> LERange Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYS'Y'EfYI. . :..- <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.l 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 Contractors Law 18.27 RCW and 296.200A WAC <br /> City of Everett Official Use Only <br /> PERMIT# E I(,�,6-7-1)-Zq <br /> I Q01 "D— I- <br /> Owner orized Agent Signatu Date (Revised 5/20/2016) �3p <br />