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PERMIT APPLICATION BUIL.DINWECHANICAL/ PLUMBING /SIGN WINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 l FAX 425-257-8857 l(E)everetteps@everettwa.gov l www.everettwa.gov/permits - - PROJ�GT SITE:INFORMATL®N PROJECT SITE ADDRESS: IPROPERTY TAX#: i--f LU- LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) `:;CONTA4T INFORMATION T p/-/, TENANT NAME(If Commercial): O G✓�'n' � n`� OWNER NAME: 1l TU p OWNER MAILING ADDRESS: STREET jR () 'p CITY (zV,�// r' �i l STATE (fir zip L`,,� .�� T Z� `1�� 17 OWNER EMAIL: G1 e�E' �G10 7 �'�d OWNER PHONE: J . .. CONTRACTOR NAME: �G✓/yC�/ CONTRACTOR ADDRESS: STREET CIT, STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: E;OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: d l CONTACT PHONE: 3 Yj `3(1-3V L_ S-TC�sYG /l-�TL j�d1� CONTACT EMAIL: � ��i�;��?r"� k%f qtr 1�ec''w BU.ILDLNG,PERMIT APPLICATION Existing Use of Building: 1��rL1C Tlf�t- �'3� L" t�ljn Contract Price of Work:$ ?/ �1 l Heat Source: ❑Gas Electric ❑Other Proposed Use of Building: / � Building Type: ❑SFR-Detached FR-Attached ❑Duplex Multi-Family#of Units: ❑commercial ❑Industrial Type of Project: EINew ❑Addition ❑Remodel Aepair EIT.1. E7Sign OSprinkler ODemolition ❑Change of Use DESCRIPTION OF WORK: 12-11- c�/r-71 G ('X1577A-4G 006 ' lZeTLACl^(U ASSOCIATED BUILDING PERMIT#(if applicable): : PE.R.MITAPPLICATION MECHANICAPLUMBING PERMIIT APPLICATION. '. L � . Type of Project: _New _ Addn Alteration _Repair Type of Project _New _Addn _Alteration _Repair #of #Of #of List of Fixtures List of Fixtures #of List of Fixtures List of Fixtures Fixtures Fixtures Fixtures Fixtures A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeration Shower Floor Drain. Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas Range Hood Water Heater Other: Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: ;SPRINKLER 1_5ILMP;RES$ION SYSTEM,: Number of Heads 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 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 Building Official before being authorized under any circumstance. I am the owner,or i am authorized by the owner of this property to perform the work for which application is made, and 1 comply with the State Contractors Law 18.27 RCW and 2g6.200A WAC. City of Everett Official Use Only PERMIT, ,, Date (Revised 10/12//1 Owne Authori d A ent Signature 2015)