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� �IE��iB�A���9CA�"90�l� <br /> �111LDING / IViEGFid�NICAL/ PLIJil��I�lG /SiGi� 1 SPR9P�KLER/ DEiV10LIT'IOtV <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 /> q�iue o� �i�c� s�,�onsy �o��s�) ��o��c� si�� '����mw°�aor� <br /> PROJECT SITE ADDRESS: � ,� ,��- ,f`v✓t �� �,!'L PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> COM7'�1CY Y�1�ORIVIA7'90PY <br /> OWNER NAME: �, � 5 S �,� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREEr .,Z� � � �" '; �t � �' <br /> CITY ��„(` f� ��" STATE �/" '� ZIP � f/� � <br /> OWNER PHONE: e�� � - 5� - C_ OWNER EMAIL: ' IL C� � 1. � � G (1„ <br /> CONTRACTOR NAME; - I , ,�l L <br /> CONTRACTOR ADDRESS: sTREET ��� �- ) �� �/',Z, ,�/�� <br /> CITY �'1/�„�'� ,� v STATE ��l/' i ZIP � � �;7�� <br /> CONTRACTOR PHONE: ��;tiS^' ,�<) � � _S -[� CONTRACTOR EMAIL: 'r ��r `l � � L (c 1 ✓�� '; � ; (-�r�( <br /> CONTRACTOR LICENSE#(REQUIRED): ('y L � � j � CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): S� L S <br /> PRIMARY CONTACT: ❑ OWNER �ONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME:_f � �,` CONTACT PHONE: j��� � - � 5�C> - � � L ,�. <br /> � '�� f" � CONTACT EMAIL: t���,� z;�, j 1 �� � . . � <br /> BUILDING PERMIT APPLICATIOQeI <br /> Existing Use of Building: Contract Price of Work: $ � . -� <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: ' � /`�� � � (�r✓ , � � �� (�� / / V �n ��/ 6 ,� <br /> V� J J G ( LI.I�L� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PE62MIT APPLICATION PLUMBING PERMIT APPLlC�TION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #�f List of Fixtures #�f List of Fixtures #°f List of Fixtures <br /> Fixtures 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 /> SPRIldKLER/ SUPPRESSION SYSTEM <br /> Chemical or Water No. 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 law. The granting of a permit only aufhorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance./am the owner,or I am authorized by the owner of this property to perform tl�e 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 /> � ��F��� -, � �— I � PERMIT I � I I.� ��Q� <br /> � � <br /> Owner/Autho zed Agent Signature Date (Revised 9/23/2016) <br />