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PERMIT APPLICATIOII <br /> BUILDWG : ::_ECHANICAL / PLUMBING / SIGN 'RINKLER / 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� www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: li L ? �- ! C!:/�e`/r �'�' <��'�-;" PROPERTY TAX#:c� �y, � ` �. � �c��t--c�-� <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> , <br /> OWNER NAME: / ���, �c� j",!% � ' ��/ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReer ,��.; � , � , ,� ` " .;�:.� <br /> � <br /> CITY �'`''Y y?�/..� -� srnre�„�l� ziP�` � <br /> OWNER PHONE: �?J � ` �v C�./� � „ < OWNER EMAIL: <br /> CONTRACTOR NAME; ,� ,/'��. � ,s ,�;� � ` -- • � � <br /> CONTRACTOR ADDRESS: srReET ��L� : vf�y- /� '� ��' �i �/� <br /> ��� <br /> CITY /` (J/- ��r .<�- STATE L�� ZIP �(,�G� <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): -!��' G�/���'� ' �,�� �� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER �1 CONTRACTOR ❑OTHER(Please Specify) <br /> ; <br /> CONTACT NAME: CONTACT PHONE;.)` � . �,I c.� ,. � �r �j <br /> '� / l�. 'P � - y� CONTACT EMAIL: , , l/� / � > _ / <br /> %i 1 L ,'9 s%°!t f ' c 'iI�` ,�� � i <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ���'.-�,�,'1;�.� "� c� �`� Contract Price of Work: $ y %j�'i'�'"' <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 /> %:6-,' '�c/%�i '%�G � c: �' <br /> �r ����� � �� <br /> � �`�C.=.��1 ,fi' %a� ��''ci � <br /> ASSOCIATED BUILDING PERMIT#(if applic�ble): ���`� '�`,?��'� � <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 #of List of Fixtures #of Lisf of Fixtures #of List of Fixtures <br /> Fixtures Fixfures Fixt res 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 fhis applicafion and confirm ihe information contained herein is true and correcf. 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.1 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 State Contractors Law 18.27 RCW and 296.200A WAC. <br /> ,/ City of Everett Official Use Only <br /> ;%,:� *� <br /> PERMIT# <br /> � �%^� � i;%� �f�l� �;�� � � ��' l D�-�� <br /> OwnerlAuthorized Agent Signature � Date (Revised 5/20/2016) <br />