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f'�F�MI1' APPLICAl`IORI <br /> BUILDIi�( NiECHAi�IC„�L I F��l1NIIBIPVG /SIG�{�RINFCL.ER I DEII�OL.ITION <br /> - C1TY O�EVERETT PERMIT SER <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 /> ' - PROJEC'1"SITE INFORNiAT10N:i ` ` , <br /> _ <br /> PROJECT SITE ADDRESS-; PROPERTY TAX#: <br /> %)I ' <br /> LEGAL for new construction: Short Plaf/subdivision Lot No. (atfach copy of long legal description) <br /> _ _ , <br /> , <br /> CONTACT. INFORMATION <br /> OWNER NAME: ' �- : TENANT NAME(ffi Commercial): <br /> � , r t <br /> OWNER MAILING ADDRESS; sTReeT /L�� �;j ��� �,�� ;'%`;O <br /> �- <br /> CITY i' STATE � ' ZIP ���;% : ..fi�� �1`. <br /> OWNER PHONE: � � OWNER EMAIL: L.1/C i' `�1,9e f:' '�' l + :`1' � ,, - <br /> � , <br /> _ ;•' ✓ ' � � <br /> r <br /> �.. .....:. ..,, _ ....... ..... .: .. ........ . ., .-. . . .. ._. .. . . .. <br /> ....:._:,... ...._. ., . . . .. .. ... .. .. . ..... ... ... . �� <br /> CONTRACTOR NAME; �; '�� � ��° <br /> CONTRACTOR ADDRESS: srREeT <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRAC70R LICENSE#( EQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME � - � -, CONTACT PHONE: -� ; �� %7 r;� - "' <br /> o�;-.; <br /> �" , � x + , " ,. �' % i �- <br /> CONTACT EMAIL: �y �',�yj�����,'��%r,`=`'�{'t ;�� ' A,,: .; ; yr <br /> ' ' BUILDING PERMIT APPLICATION ` <br /> _ _, <br /> ,. ,. ,� ,-� <br /> Existing Use of Building: Contract Price of Work:$ r, <br /> Proposed Use of Building: � Heat Source: �Gas ❑Electric Other Y�O��� �-.-tU dC_ <br /> Building Type: ❑5FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: C�New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 1���C� `>�L.C.C j�l C� � <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> ' :MECHANICAL PERMIT APPLICATION PLUMBING PERMITAPPLICATION <br /> Type of Project: ^New _ Addn _Aiteration ,_Repair Type ot Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #�f Lisf of Fixfures #�f Lisf of Fi�cfures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump �/ Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathfub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration % Shower Floor Drain <br /> Gas Fireplace �,- Wood Stove Kifchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Ofher: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan t Sink(Service/Bar/Mopletc.) Other: <br /> SPRINK_LER!_S_UPPRESSION SYSTEM_ <br /> Number of Heads <br /> ACKNOWLL-DGEMENT.'!have reviewed fhis applicafion and confirm the information contained herein is true and correct. Work done pursuant to this permit musf comply with <br /> current federal,state,and locallaw. The granting of a permit only authorizes approved work and no deviations therefrom.CJeviations must first be aufhonzed in writing from the <br /> Building Otficral before being aufhorized under any circumstance.1 am the owner,or!arn authorized by the owner of this p�operty to perform fhe work for which application is made, <br /> and/comply with the State Contractors Law 18.27 RCW and 296,200A WAC. <br /> Cify of Everett Official Use Only <br /> f,� PERMIT� � <br /> �. � <br /> Owner/Auf e ignature Date (Revised 90/12/2015 <br /> ,� �l <br /> ���� ��c-�5-� � � Z <br />