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PERMIT APPLICATIO <br /> BUIL.DINC�ECHANICAL / PLUMBING / SIGN�'RINKLER / DEMOLITION <br /> CITY OF EVER�TT PERMI r SL-RVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)�125-257-8810 � F/1X 425-257-8857 � (E)everetteps@everettwa.gov � www.everettwa.gov/permits <br /> (Blu� or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: �����j,� ��,��1�C'(���1 L��L ��,�f I C`j PROPERTY TAX#:����`�� 13�Ci 3C;�� ,- Ey(�i� <br /> LEGAL for ncw construction: Short Plat/subdivision � L.ot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ����(;; �'� ��C�� �� TENANT NAME (If Commercial): LCj(G��i � � � Ci�,l'V'� <br /> OWNER MAILING ADDRESS: srk�r r ��� � �( ' �,�;(,� ,�� <br /> CIIY 7 ��L� STAiF. � LIP �CJE��/ <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME G r j�'� ���lT�y�c Ci✓tJ 1�:�;� �� I�C <br /> CONTRACTOR ADDRESS: srkr E r � ,���� <br /> crrv ` k(Gt�L' sTnTE_ , ziP �(;7'(,.r.�.,� <br /> CONTRACTOR PHONE: �?5 ` LiL�-I' �2�1�, CONTRACTOR EMAIL: c�f�Y� (�� L�M'�{��C� ���' <br /> CONTRACTOR LICENSE#(RFC1UIRf D): �. r' J�'�N� NC�lt'� C� CITY OF EV�RETT BUSINESS LICENSE#(REQUI ED): S 53 <br /> -�.��. <br /> — <br /> PRIMARY CONTACT: ❑ OWNER �CON�RACTQR ❑ Ol-HER (Please Specify)_ _ _ <br /> CONTACT NAME: CONTACT PHONE: ��> ��Z(- ��G3 <br /> �17.�1��Y1'� �'�CL,II�� CONTACTEMAIL•��r�pb+ � �� �C= �(l�_ C(�,��'� <br /> BUILDING PERMIT APPLICATION � <br /> , ; , <br /> f::xisting Use of Building: �, •(.,� Contract Price of Work: $ � <br /> Proposed Use of Building: � • Q, tleat Source: �Gas ❑F`ectric Other <br /> f3uilding Type: ❑SI R-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 Usc <br /> DESCRIPTION OF WORK: <br /> �v��'i,�c�t�. �6�C-i,��`�i e,+�5 -�►' � �x���5�-i �� .� C �.��i� i,�;,��i 5��1��/ �' <br /> ( ��.�� c�1r4 �1�� � � �JC�ZJ1�e"�;)'!Yl 'L'�U�GIL:J� ��Y�� <br /> f <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHAPIICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: __New Addn Alteration _Repair Typc of Project: _ _New Addn Alteration Repair <br /> #of List of Fixtures #of List of Fixtures #pf List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventcr(Inside Bldg) <br /> f=orced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping [3oiler Lavatory(Wash f3asin) 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 Qrains <br /> Clothes Dryer Hookups Other: Clothes Washer Mcdical Gas <br /> Range Hood Water fieater Other: <br /> Z, E:xhaust Fan Sink (Service/f�ar/Mop/etc.) Other: <br /> SPRINKLER / SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT.�1 have reviewed this application and confirm the in(ormation contained herein is true and correct. Work dono pursuant to this permit must�ornply with <br /> current federal.state,and local law. The granting nf a permit only authorizes approved work and no deviations therefrom. Deviations rnust first be authorizcd in wri�ing frr�m thc <br /> Ruilding Official before bcing authorized undor any circumstance. I am the owner,or I am authorized by the owner of this property to periorm the work for which applicatlon i;mnclo, <br /> and 1 comply with the State Contrar.tors Law 18.27 RCW and 296.200l� W/1C. <br /> City of Fverett Official Usc Only <br /> �� � .�L�� � � -���'�-�� � �'' � '31 � PE rr ���� � ��� <br /> Own IAutho�ed gent Signature f)ate (Revised 5/20/2016) <br />