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� � ' <br /> PERMIT APPLICATION <br /> BUILDING /MECHANiCAL I PLUMBING /SfGN 1 SPRINKLER/DEMOLITION ' <br /> CITY OF EVERETT PERMIT SERVICES I <br /> 3200 CEDAR STREET,EVERFTT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteos@everettwa.gov� �w�w.everettwa.gov/permits <br /> :- : PROJECT SITE<INFORMATION- I <br /> PROJECT SITE ADDRESS: , , PROPERTY TAX#: <br /> ����� w�t i C�-E'h�i.�(�r . <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long Iegal description) <br /> ` CONTACT INFORMATION ` ' <br /> OWNER NAME: � �f . � �. ; . "� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReer �(`SG�' ' Li IL�(� � C�'�I� vv 1"' 'I 71��j'� I <br /> CITY STATE ZIP � <br /> ��1 � <br /> OWNER PHONE: —12 S o��J f - Cj a LI�� OWNER EMAIL: S�"� �� ���, (,� ' {�� (1 <br /> CONTRACTOR NAME; <br /> — _ i <br /> CONTRACTOR ADDRE55: sTReer <br /> i <br /> CITY STATE ZIP <br /> � <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: � <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L�a �-a 3 I _ S �y c� �`� �L�.�j - �_�3 j <br /> S t(����� (11'� �� � ; ��/)�-' ��� CONTACT EMAIL: � <br /> BUILDING PERMIT APPLtGAT10N <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 /> , <br /> Type of Project: ❑New DAddition ❑Remodei ❑Repair ❑T.I. ❑Si n ❑S rinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ' ��,� ��� �,� � I����L �f F <br /> �/� G'� � I � �, �11.�,�t� �"G �'�,�L'J <br /> ASSOCIATED BUILDING PERMIT#(if applicable): - <br /> f <br /> MECHANICAL'PERMIT APPLICATION PLUMBING PERMIT APPLICATION'' ; <br /> Type of Project: New _ Addn _Alteration _Repair Type of Project: New _Addn _Alteration _Repair ` <br /> #�f Lisi of Fixtures #�f List of Fixtures �°f List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fi�ures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Sidg) <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 k <br /> Gas Range Ducting Dishwasher Roof Drains ! <br /> � <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 /> Number of Heads ;1 <br /> ACKNOWLEDGEMENT.1 have reviewed this applicafion and confirm the informafion contained herein is true and correct. Work done pursuant to this peimif must comply with <br /> current federal,stafe,and local law. The granting of a permit onty authorizes approved work and no deviations fherefrom.Deviations must first be authorized in w�iting lrom the <br /> Building O�cia/before being aufhorized under any circumstance.!am the owner,or 1 am authorized by the owner of fhis property to perform the work for which applrcatron is made, ' <br /> and/comply with the State Contractors Law 1827 RCW and 296.200A WAC. �3 <br /> , <br /> City of Everett Offrcial Use On1y <br /> � PERMIT# <br /> ��L� :�,� 7� �� �� /� i 7 '�� 'b <br /> Owner/Authoriz d:A ent Signature Date {Revised i0/12/2095) <br /> i <br /> N <br /> i' <br />