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PERMIT APPLICATIC: . <br /> BUILDIN. � �AECHANICAL I PLUMBING / SIGN / SPRINKLER / 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 S1TE INFORMATION ' <br /> PROJECT SITE ADDRESS: �� Cl� LU�✓c%f ��fL PROPERTY TAX#: Cl�'-!j`�J(�����I�a <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> ' CONTACT iNFORMATION <br /> OWNER NAME: _ �%���!,;�I TENANT NAME (If Commercial): ("�,-. ;,1 (� <br /> OWNER MAILING ADDRESS: srReeT � ,zr - 7 <br /> CITY STATE ZIp �(?6 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: �, t.l no �':{ Vji <br /> CONTRACTOR ADDRESS: srReer � � � S�_ Sk <br /> CITY ny�r�-(� STATE q ZIP ����,� <br /> CONTRACTOR PHONE: �,�� � �� ! CONTRACTOR EMAIL: � �I,(Lc S ������-L ,L„y„� <br /> CONTRACTOR LICENSE#(REQUIRED): I� �-�j� C�?-,3L, CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): �^�����C1 <br /> PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: �, CONTACT PHONE: �,,Z�- ����- �,�.;t(� <br /> �a"'`— t�'����' CONTACT EMAIL: ' 1 �' <br /> ;t.���,�'.;:;�; ��{,��,.'_ ; �C-.�,1 <br /> BUILDING PERMIT APPLICATION ` <br /> Existing Use of Building: Contract Price of Work: $ 7 ���:': <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: /1� � � � � � ' I � f � ��'I � I� �,h�. <br /> FII.G J�`Y'4 vnvw� Si � �„� S�v��C- Gine C��Gt �!i C�. �<<�� , �r 1Ce v�x: � <br /> (�:����� yhc,� <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 k' Alteration _Repair <br /> Fixtures List of Fixtures Fixtu es List of Fixtuies #of List of Fixtures #of List of Fixtures <br /> 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 i Other: , , >�- <br /> Exhaust Fan Sink(Service/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 ihe 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 /> f; /`�" � � � I / l� PERMIT#�� � <br /> �1 <br /> Owner/Auth rized Agent 5ignature Date <br /> / (Revised 5/20/2016) <br />