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PERMIT APPLICATION <br /> BUILDINAECHANICAL / PLUMBING / SIGN 40RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> OL (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SIT ADDRESS: PROPERTY TAX#: <br /> ari in e fSA' O'kUrc <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> --T� CONTACT INFORMATION <br /> OWNER NAME: C��! C� V��G��U S TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET p / �y <br /> CITY ---SGL{ e C- �. C� O 1 O STATE `,,' cz ZIP( 9 <br /> OWNER PHONE: C-a�- 6 OWNER EMAIL: G�1 <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: [A OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME:pe ---� CONTACT PHONE: �'�c C') <br /> t^RQ5 CONTACT EMAIL: G�qv ccs evr\Ccs `�S� G\��`mQt � ' co <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: <br /> Proposed Use of Building: S (� Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached IXSFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: El New ❑Addition 11 Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ADernolition ❑Change of Use <br /> DESCRIPTION OF WORK: ��[[�� t e t <br /> Rewtec�C�� It-C-1 � � tcJ '9p b\ovl—\� ��4.v–Iv2cy <br /> ASSOCIATED BUILDING PERMIT#(if applicable): E fn"v+ ('( b yj " <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT 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 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: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. I am the owner, or I am authorized by the owner of this property to perform the work for�RT7�made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official <br /> PERMIT# ^Pll/I k 0C <br /> Owner/Authorized Agent Signature Dat (Revised 10/12/2015) <br />