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PEHNIIT'AF'PLICATIO� <br /> �U11.DIi� fV1ECF#ANICAL/ PLUf11iBING /SIGN /�'RIN6fLER/ DEflfIOLITION <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�lack Ink Only Please) PROJE�'I'SITie IiNFOFtM/4YlO1V <br /> PROJECT SITE ADQRESS: J 3 3 Z E- n'1�n�N � �/�b� .D� PROPERTY TAX#:p�,y 3� � z5�7 ��c�i�c� <br /> LEGAL for new construction: Short Plat/su6division Lot No. (attach copy of long legal description) <br /> COWTACT INFORM/47'IOPI <br /> OWNER NAME: '� P+-��l-i-� L}�l"lS�n TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReeT ���Z E M.4 e�,�� V��1-.� �2 <br /> ciTv ��I£2�'�" STATE �J-� ziP 7�Z�� <br /> OWNER PHONE: �Z� (�/f� C� �5'7 OWNER EMAIL: /'1��1��k�erhs v-2(�['�M t,45T• N�.+ <br /> CONTRACTOR NAME: 7 /�rc-�r� V,4/2AG>�5 l,ti� <br /> CONTRACTORADDRESS: sTREET �'w�t L���y ,�,� U,v,r � <br /> CIN ��Q�G�� STATE �d ZIP �'�u�%� <br /> CONTRACTOR PHONE: �/'Z->' S�D� �I-�-SL CONTRACTOR EMAIL:�n-O�-Scs/N f'a�-IFiLL'4'=,a6-t>~ Le."' <br /> CONTRACTOR LICENSE#(REQUIRED): ������"�y��r`S.,J J� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): � // / C�f� <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �zi" S'U� �}-�',�Z <br /> � <br /> li_� ��S�'� CONTACT EMAIL: ��_u�-Sc,w,� L'.�r4-t.iFi�G�.46:t7 ._ La� <br /> BUILDING PERMiT APPLICATION <br /> Existing Use of Building: ��'-�'� Contract Price of Work:$ _�G,C=Ut�. `'`' <br /> Proposed Use of Building: ' '4�2L Heat Source: ❑Gas ❑Electric ❑Other �6i�� <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: QNew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: �+4os� �r c���� :-�• 5.�+� Z«��T�� <br /> �Oc:Mcc..i4� �.risr,,�V �`ttJ.".:� Pr G,�'A�i�P'j Cl��:.�s7'rw�_-r !✓bi,u <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ��� �Y � � <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Projecf: _New_ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #�f List of Fixtures #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 Bidg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Qa in)J Drinking Fountain <br /> Water Heater Refrigeration Shower � Floor Drain <br /> Gas Fireplace � . Wood Stove Kitche��ink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Qry2r Hookups Other: Clothes Washer Medical Gas <br /> Range ood 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 tl�is 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 loca!law. The granting of a permit only authorizes approved work and no deviations theref�om.Deviatrons must first be authorized in w�iting from the <br /> Building Official before being authorized under any circumstance.1 am the owner, or I am autho�ized by the owner of fhis properfy to perform the work for which application is made, <br /> and I comply with the Stafe Contractors Law 18.27 RCW and 296.200A WAC_ <br /> � � City of Everett Official Use Only <br /> PERMIT# <br /> /� - �� 3 f// �( l (�� � � ;-��, <br /> Owner/ thorized gent Signatu Date (Revised 9/23/2016) <br /> '�z <br />