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PERMIT APPLICATIO <br /> BUILDINAECHANICAL / 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 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PP,OJECT SITE ADDRESS: PROPERTY.TAX#- r <br /> G �Gt YC I t <br /> LEGAL for new construction: Short Plat/subdivision �� q< K W Z Lot No. Z7 Lattach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: f, f�. L_ol- C TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREETi - <br /> CITY L::�' /- STATE ZIP C ) <br /> OWNER PHONE-.. f e - 177OWNER EMAIL: 0' ( (A ',(.:( � <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): I CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 9"OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: r( <br /> CONTACTro <br /> EMAIL: r( cc, C <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: � Con ract Price of Work:$Q.S- 1 cr- w <br /> Proposed Use of Building: ' 4 Cti f ✓ Heat Source: ❑Gas R1=`lectric ❑Other <br /> Building Type: 2!' FR-Detached tj❑SFR-Attached Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: []New ❑Addition 6<emodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:c. V� ek— <br /> J i-tY�-7 C c� Y DSS b <br /> AS(ZA4 <br /> u IL&QbN�iWoplicable):=LQ� c,J 6 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn Alteration _Repair Type of Project: _New _Addn '�,LAlteration _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 Sin I 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:/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. t am the owner,or l am authorized by the owner of this property to perform the work for which application is made, <br /> and/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Owner/Authorized Agent Ig ature � Date (Revised 10/12/2015) I t" <br />