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� PERMIT APPLICATIO� <br /> BUILDIN ECHANICAL / 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 �(E)everetteps@everettwa.gov� www.everettwa.govlpermits <br /> PROJECT SITE INFORMATION <br /> P �� IT�DDRE : _ ��, PROPERTY TAX#: ���c,, � / ���,��1�c�Q <br /> b �ff ?� <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:�y�.�..� � r � TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReeT GT(�vr� {►�Q_ <br /> CITY �tZ�l' � STATE ZIP �g � <br /> OWNER PHONE: �rJ'—���- ��1 � � OWNER EMAIL: <br /> CONTRACTOR NAME; 'V GRVT1 C�G� � 1^S ,�„rl ' <br /> CONTRACTOR ADDRESS: srReer �Q . (��j� <br /> CITY S STATE ZIP �+ <br /> CONTRACTOR PHONE: '�-I-c�J-- — 'C ��" CONTRACTOR EMAIL. C i C V' —C�"J � �4 <br /> CONTRACTOR LICENSE#(REQUIRED): 1'{��I�N C.1 {�3 IyI � CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ,'�. � � A� <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONT`NAME: CONTACTPHONE: �� ---3�g--�3C1(3� <br /> � �'�1� � S�- CONTACT EMAIL: ^-�-��f � �.,� Y q.� ,— CJ ri t'C��L, C�TS� l� <br /> BUILDING PERMIT APPLICATION <br /> Existin Use of Buiidin : Contract Price of Work:$ � d� � <br /> Proposed Use of Buildin : Heat Source: ❑Gas ❑Electric ❑Other <br /> Buildin T pe: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> T e of Pro'ect: ❑New ❑Addition ❑Remodel ❑Re air ❑T.I. ❑Si n ❑S rinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: R�_s� ,Q S�o V'I'k 27c.'E'��i oir e eV�C. ��h Y(V( �� �-� r �—� P �An K �� <br /> q , 1-l�a� Fc�. <br /> �~o pVl,w� �c.Sf � �eva.�la� ( d one �n 2o I+�-), � �15�'aL� Jte.�.� W R B <br /> i�V indo�s aKd i nsk�c.l) Vte�,.i roo{'�o�►-�-�et �l.�s�;s , 2�s �'l� �c� ��ne.� � <br /> ASSOCIATED BUILDING PERMIT#(if applicable : w 1 n D� ��t yY� e,, 0.Y <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn A�teration _Repair Type of Project: New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixiures #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 Bld ) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavato (Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Ran e Ductin Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Neater 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/aw. 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 1 am authorized by the owner of this property to perform the work for which applicatron 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 /> ��� � �� � � PERMIT# � .' ` /�� <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) � <br /> � � <br />