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• PERMIT APPLICATION, <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> E 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE:INFO.RMATION! <br /> PROJE� ' ADD ES r,�C, + .lP`/ /�/u� PROPERTY TAX#: (j �� <br /> LEGAL for new construction: Short PPlat/slubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: .r (/1.W ANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET — <br /> .0 (1�(>�' G/ / <br /> CIT' C/�-P �/ STATE �� zip 03 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: d� I' r�/ ' ,J(_' r" 1 <br /> 411-J) <br /> J <br /> r <br /> CONTRACTOR ADDRESS: STREET e7.7.a fJ t jL e <br /> CITY f�v`e �-j e �-�e ,uS i STATE Vl.i ( ZIP <br /> CONTRACTOR PHONE: L - �; p �)�i s�j CONTRACTOR EMAIL: L-' t Cy , 1� kji Y 11 0 C��Y►'/ <br /> CONTRACTOR LICENSE#(REQUIRED):-J P r ry " CIS L/ 6)(`� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER C CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: G, </ el S <br /> CONTACT EMAIL: J L� <br /> BUILDING<PERMIT APPLICATION <br /> Existing Use of Building: ( C Contract Price of Work:$ 60L <br /> Proposed Use of Building: (' u re kl 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 /> R ("IMc'A(JI ) 190-0 -� n uac <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATIONPLUMBING PER 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 /> 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 Grdase 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 Ji;SUPPRESSION SYSTEM <br /> IN umber of Heads <br /> ACKNOWLEDGEMENT.,1 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.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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Ow r/Authori ed Agent Signature Date (Revised 10/12/2015) t r�'6 0 0 <br /> t <br />