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PERM17' APPLICA7 <br /> BUIL�G I �IIECHANICAL/ PLUMBING / SI ,d SPRIRIKLER/ DEMOLII'ION <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.gov/permits <br /> (Blue or Black Ink Only Please) PROJ@CT SITE INFORMATIOW <br /> PROJECT SITE ADDRESS:�� �f� I��i�j P �� , ?11 .�„�� j J/�a/� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACY INFORMATION <br /> OWNER NAME: � <br /> �/y� (�,t-sp TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReEr �t� � � � � ', ��G�I� �'�J,/tir�, <br /> ! �� <br /> CITY / STATE UVj� IIP �lJ <br /> V.5�i� <br /> OWNER PHONE: �� ^ 2�� �� � OWNER EMAIL: <br /> CONTRACTOR NAME: �j'V C1 i � � <br /> CONTRACTOR ADDRESS: sTRee-r '�l(c� �Ijti� ' <br /> cirr 'G r �vv�- sraTE ��(c� ziP '���" <br /> CONTRACTOR PHONE: _ � � �D � CONTRACTOR EMAIL: C�{J Ii(�� �-� �%� ca��` G �i;� Lc;'Ytti- <br /> CONTRACTOR LICENSE#(REQUIRED): � �� ' (L '��� CITY OF EVERETT BUSINESS LICENS #(REQUIRED): C> S�Od v <br /> PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: � CONTACT PHONE: Ct-Z,j—= 7 �`.r�]�� <br /> J CONTACT EMAIL: V�l(��•�' 1 Y .y� �c' ��P�;G', t-�s�-.-�- <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ ` ��b '- <br /> Proposed 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 /> i'/�� ��t� ��G?���j�.(� ���,,� � ti������,� />��� S�f�-� <br /> � J <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 Fixtures #of List of Fixtures #°f List of Fixtures #°f Lisf of Fixtures <br /> Fixfures Fixtures Fixtures Fixfures <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 Water No. of Heads <br /> ACKNOWLEDGEMENT:l have reviewed this application and confirm the informatron 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 Offcial before being authorized unde�any circumstance.I am the owner,or I am authorized by the owner of this property to pertorm the work for which application 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#;(�'��.���On -1 <br /> � �' <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) � � � <br /> � <br />