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I <br /> PERMIT APPLICATION <br /> BUILDINC�ECHANICAL / PLUMBING / SIGN .�RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICE <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E)everetteps@everetiwa.gov� www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: -7 PROPERTY TAX . � <br /> .z , �� t/�� r�� � ; �', ,_ '� .. � _ <br /> LEGAL for new construction: Short Plat/subdivision Lot No'� (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: C'��.E,� ���',�(Q TENANT NAME(If Commerciai): <br /> OWNER MAILING ADDRESS: srReer /� a'/.> � � ��.,� �.5�' <br /> ��C,`—��L'--�(� cirr sTaTe \�H'�-- ziP �'���) r� <br /> OWNER PHONE: L� ^�l��-(i�3 lj OWNER EMAIL: ��/��/�J,S 7��iJ' C"�Cy/�j�-tG • C4�1`� <br /> 'E CONTRACTOR NAME: +��[/�Ef� <br /> �. CONTRACTOR ADDRESS: srREeT <br /> CITY STATE ZIP <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: P�l`��.�i � }�-G�L/ CONTACT PHONE: !f� — _Z��—,�Y3� <br /> CONTACT EMAIL: �..n�j'1d?�/�J��✓,�i�ju +�—�r ,, ' �L�( <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ��� — �¢-v/ ` � �2 Contract Price of Work:$ <br /> Proposed Use of B ilding: B' " '` $FdL Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: SFR-Detac d ❑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:t�� ��� ���Q� t�`� �-'_�,�-����fi �c������(G-� <br /> _"'�� �_� <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 Lisf of Fixtures #�f Lisf of Fixtures #of ��st of Fixfures <br /> Fixtures Fixfures Fixfures Fizfures <br /> A/C—Air Handling Units Heat Pump �Z, Toilet Backflow Preventer(Inside Bidg) <br /> Forced Air Systems Unit Heater � Bathtub Urinal <br /> Gas Piping Boiler � Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration �2 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 /> Number of Heads <br /> ACKNOWLEDGEMENT:1 have reviewed this application and confirm the information contained he�ein is true and correct. Work done pursuant to this permit must comply with <br /> currenf federal,state,and local law. The g�anting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance. I am the owner,or 1 am aufho�ized by the owner of this property to perform the work for which application rs made, <br /> and I comply with the State C ntractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> z-------- ' � P E RM IT# <br /> �-- �� 3 � .��I ,� C l l�a �_ <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) �7 j <br />