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� P�R�/i9T'A�PPLIC�,TIOflI • <br /> �UILDI�G / IV1EChIANIC�4L/ PLUIVl�9NG / SICf� / SPR9�19SLER/ D�IVrOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,`,NA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> (Blue or �lack Inlc An1y Please) �6t�JECT SITE 9���12NVAT10�9 <br /> PROJECT SITE ADDRESS: �-��L�� S, 1•t� ���` # L. PROPERTY TAX#: (� c,soc 3o�i�c U <br /> LEGAL for new construction: Short Plabsubdivision Lot No. (attach copy of long legal description) <br /> GOIdTAC'➢' INFORMATIOf+I <br /> OWNER NAME: � �, � --�— TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReET �.i° -��C l� ; <br /> CITY �/�.� � STATE l/��� ZIP C� ��,� ` <br /> OWNERPHONE: —2 ; O� OWNEREMAIL: �C�..s� `�'� � QVl''I�CL L��IPC 1�IINC� �� <br /> CONTRACTOR NAME: � � <br /> CONTRACTOR ADDRESS: srREEr Z � ,F I-'7� ��Q <br /> � <br /> CITY ��l iC. STATE ZIP ��`'' I <br /> CONTRACTOR PHONE: ,-;'i'��.� .�j L.- (p � C�� CONTRACTOR EMAIL: � �l� v`- tI r �� <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR IXI OTHER(Please Specify) �� <br /> CONTACT NAME: � �y�-�� ����y�,Q[-;}'�-j� CONTACT PHONE: C�ZS -3� '�7,—(a�'� <br /> 5��,�\�Sz �'�"'t v�'b CONTACT EMAIL: � ��c� +--�� jiIQC-7/�Y)117L�- <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: /��-S t�CS�c�,'���_ Contract Price of Work:$ <br /> Proposetl Use of Building: Heat Source: ❑Gas �Electric ❑Other <br /> Building Type: ❑SFR-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 Use <br /> DESCRIPTION OF WORK: <br /> �--��p(-�. C� c.���--�t��r-���-��/ /',.�P�� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <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 Fixiures #of Lisf of Fi�ctures #�f List of Fixtures #°f List of Fixtures <br /> Fi�rfures 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 /> Chemical or VVater No. of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the inrormation contained herein is true and correct. Work done pursuant to this permit musf 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 Officral before being authorized under any circumstance. I am fh2 owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply wifh the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> I City of Everett Official Use Only <br /> PERMIT# <br /> f f � <br /> ; , - -�" v �� �� ;:�� �� ����j �_, <br /> Owner/Authorized Agent Signature `� Date (Revised 9/23/2016) <br /> � <br />