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PERMIT APPLICATIO <br /> BUILDINAECHANICAL / PLUMBING / SIGN RINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OL3200 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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: )-')1I \-,\L\\\•l\ t_C �v C. TC'Jexc\ C W(N' I PROPERTY TAX#:0U';)L--L JOS(0 CA C) 0 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 7 a �-�L��-jL-� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET t bLi &\ <br /> CITY �v �� -1v STATE 4\1 \ \ ZIP <br /> OWNER PHONE: OWNER EMAIL: c%Cj" _ �� c* `\l��M�\� (moo <br /> CONTRACTOR NAME P oo'.X\ VA <br /> CONTRACTOR ADDRESS: STREET <br /> CITY �-7 STATE \ \ ZIP C Lo \ <br /> CONTRACTOR PHONE: WLCC Y\S ' ySyLS CONTRACTOR EMAIL: ('Y\ %(•\ _ =3\ \--'0kMC'A• C,Om <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: KOWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: i ` _i CONTACT PHONE: 1—\-Lc- -.'13\C3--"V�Tc) <br /> C�.\.�` Vim► • ��'\t:�i0e"1 <br /> CONTACT EMAIL: (\ ue-�\'.-N _ -":>\ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ` Contract Price of Work: $ <br /> Proposed Use of Building:Ftr\\L,�h ( )Q',CmeC* F�1ac� qua\( 1h�$t, Heat Source: gGas ❑Electric []Other <br /> Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial 11 Industrial <br /> Type of Project: El New ❑Addition emodel El Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OFF WORK: <br /> 0"Amoi ac'\Lcs\ co�\C\e��`\t�`c�'\`� , �e�'G.��� (A& <br /> \uu-'t ` t � �r� � <br /> �ULa�Cis.rSr\ e\b \C�i.�C\r ;�Lm \c\.\c Ca <br /> ASSOCIATED BUILDING PERMIT#(if applicable): b e' \c,\LA ck- k `stn\i- <br /> MECHANICAL <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: New _AddnAlteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixt,ires Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet jG. Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) (r; Drinking Fountain <br /> Water Heater Refrigeration Shower <br /> Gas Fireplace Wood Stove 0 Kitchen Sink&Disposal r Grease Trap <br /> Gas Range Ducting 0 Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washers_ 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: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. 1 am the owner,or 1 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 /> /�� l PERMIT# 0(/ <br /> Owner/Authorized Agent Signature Date (Revised 5/20/2016) W � <br />