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PERMIT'APPLIC,4T'10�� <br /> BUILDIi�iV1ECHANICAL/ PLUMBING /SIGN RINKLER/ DEil/IOLITION <br /> CITY OF EVERETT PERMIT SERVICtb <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> (Blue or�lack Ink Only Please) PROJECT SITE INFORMATLON <br /> r PROJECT SITE ADDRESS: I 6 7j I �-F1 )OJ E?�' �, �:/�-r'�- PROPERTY TAX#: �'r1,°��" . ��s�.f� G.�%'� <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CORATACT IWIFORM�1�'IOId <br /> � OWNER NAME: ���71 �'�Usj�G �.5��1 � TENANT NAME(If Commercial): ��F� S ty N�v� IfUU�9 n-�(,- S <br /> � OWNER MAfLING ADDRESS: sTREEr b ' � CF d f�(�'� <br /> I —,,{ � [ /� <br /> �� CITY -�,V �_�:.� / STATE 1/`-� '�1 ZIP � U �� � <br /> �OWNER PHONE: �'�Z� Z-��7 '- � C71 Cd OWNER EMAIL: Q��s-� �/� �J ��- � �>r" <br /> __ ,.., .. .. ._, _ . ...._. <br /> _ ..._ ._..... _._. . . _ _ _ . _. _ _ . ... .. ... . . . __. __., . .. ., .... ,__..._ ._..... _ <br /> CONTRACTOR NAME: E/�l�"j��,r�- � C��� p,�- r.�. �e�t=� � �,�' <br /> CONTRACTOR ADDRESS: srrzeET � � O S �� � � S � S r � f S �C� �C� j Z.� I <br /> CITY S(� � � STATE W�-t ZIP ( '7 Z�b � <br /> CONTRACTOR PHONE �� bU� -' �U�-]O CONTRACTOR EMAIL: Z'ytU���C R-�' U"- �- . CC�:v� <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> _ ...._...... :_ _.__ _ _ _ __. .__._.._.__. . _........ __...__._ _... _ _... ___ _...._... ___ _..__. .__._ .__.. ..._... . . ........ . .......... <br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) �;��'�; <br /> CONTACT NAME: CONTACT PHONE: ��� � , �f e <br /> �� � �<<{-1�( � y ��} ���� CONTACT EMAIL: � � ��-� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ � <br /> �/ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Ofher <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: p � � � <br /> (�€�v'U rQ G; t`�ut�'� a�.i e� k6,-f .�1J f i-ffi� �.c r�, .�-,� 3J� b� �a �C r�'C"� S Lr1 � . <br /> � <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 List of Fixtures #�f List of Fi�cfures #�f List of Fixfures #of List of Fixtures <br /> Fixtures Fixtures Fixtures 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) Qrinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducfing 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 /> SPRIN�CLER/SUPPRESSIOPI �YSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT.�1 have reviewed this application and confrm the informatron contained herein is frue and correct.Work done pursuant to this permit must comply with <br /> current federal,state,and loca!law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviafions must first be autl�orized in writing from the <br /> 8uilding Otficia!before being authorized under any circumstance.I am the owner,or l am authorized by the owner of this properly to perform tl�e work for which application is made, - <br /> and 1 comply with the Sfate Confractors Law i8.27 RCW and 296.7_o0A WAC. <br /> City of Everett Official Use Only <br /> � PERMIT# <br /> � _ �Z �7 / (o ,—�l. �(��a . o �� <br /> Owner/Authorized Agent Signature Date (Revised 5/20/2096) <br /> ��� ' <br />