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PERMIT APPLICATION <br /> BUILDIN AECHANICAL/ PLUMBING / SIGN � —�INKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� wv�nv.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> ( ROJECT 51TE ADDRESS: � j 3 I �:R >pJ � f' �J�'�., ��l�-fY- PROPERTY TAX#: ��'�r���;'�✓�,;�P�, �v�,i <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> �OWNER NAME: C_v �-��i j�US��G �I �� - TENANT NAME(If Commercial): L.f�Ft- �L, M U: I-}Ci�iS a n%(, � <br /> � OWNER MAILING ADDRESS: sTREEr � �7 L � �- �'� <br /> � CIiY �V/��.� / STl�IE �r� � ZIP � �j L�" 1 <br /> OWNER PHONE: �'��`� 7.3� — �i �1 (�, OWNER EMAIL: . �� �Cv �v �/� . CS ." � <br /> CONTRACTOR NAME: �"�'���,�4�.r- ,� C.�-,^ �;� �- �e N C' � L L,� <br /> CONTRACTOR ADDRESS: sTREE-r � G S ��' � i� S r s ( C 1 S �C� rj C;�- ( Z� ( <br /> ciTv S=� ' E STATE W� ziP � L!Z� 1 <br /> CONTRACTOR PHONE ZEi� �Ut -' i—JV �CJ CONTRACTOR EMAIL: a'�1oc�� �,�C �' ' G' � . Cv rv�. <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#t(REQUIRED): <br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> ���-v�, t� " G��'�. <br /> �C, d� �I,�}-�( � � tv ��l � CONTACT EMAIL: / � - �- p V-� <br /> BUILDING PERMIT APPLICATION <br /> � <br /> Existing Use of Building: Contract Price of Work: $ >� �%C ' <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <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: <br /> 1 - � . <br /> �c��'v --�c; r� �✓J,u ��.!<���� �I i!„��t�}} I 1:-1 �.v 1� i: 4� �� .rv l r�� �.. S �.-� �1 , <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 Fi�ctures #of List of Fixtures #�f Lisf of Fixtures #°f List of Fixtures <br /> Fixfures 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) 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:1 have reviewed this application and confirm the information contained herein is true and correcf.Work done pursuant to thrs permit must comply with <br /> curreni federal,stafe,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations musf first be authorized in writing from the <br /> Building Otficial before being authorized under any circumstance.!am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the Sta1e Contracfors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Offrcial Use Only <br /> PERMIT# <br /> % --- �z � / � �C (�� - e� � <br /> Owner/Authorized Agent Signature Date (Revised 5/20/2016) I <br /> l � <br />