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PERMIT'APPLICATIOf� <br /> BUILDIN�MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <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� wv�v.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: LC�J`C' ��i(;t�l e(" GI�J� PROPERTY TAX#:��G 1�1 '� � (7Z(; G�O <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legai description) <br /> CONTACT INFORMATION <br /> OWNER NAME: � �� � � ��i� � � (� . �(�� � N TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReer �� � k��'` <br /> �_ ��� , � <br /> CITY � r ��� STATE �I ZIP ��� Z.(J <br /> OWNER PHONE: ZS� L1 • '� '�� OWNER EMAIL: ��` �. ��rQ�C�ti� tt�; � ;�C�1 . lj/)� <br /> CONTRACTOR NAME; � ,� �(j� '��\� \ f +(� ' <br /> CONTRACTOR ADDRESS: sTReEr (�S (�� j�, <br /> / , ,C ,, <br /> CITY '�Y�Y � '� STATE W� ZIP �;r�C/ <br /> �-•_ } n <br /> CONTRACTOR PHONE: �-}Z, � � 2,,S�L���I�� CONTRACTOR EMAIL: i^�C�,'v'�1:,�,L�(�:>"`1��,'nl���� ;K�� <br /> C 01�1 <br /> CONTRACTOR LICENSE#(REQUIRED): � (����(� �;��'', CITY OF EVERETT BUSWESS LICENSE#(REQUI ED): <br /> PRIMARY CONTACT: �OWNER ❑CONTRACTOR ❑OTHER(Please Specify) ��-•--• ��"-'r "-� <br /> CONTACT NAME: CONTACT PHONE: L�2� - �?�tG` . �'(�(j` <br /> '��` ������'1 CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: �-�l�'�`��l(� � �j�l� Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: FR-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: i ' �, ` t/ ,_(_/-� <br /> � � V��J���� l l V1� �J`r S1.V11�-- ! l.i <br /> �, (,������� Q � 5i1��(� . <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 Fiartures #�f Lisi of Fixtures #�f Lisf of Fixtures #of List of Fixtures <br /> Fi�ctures 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 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 /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuanf to this permit must comply with <br /> currenf federal,state,and loca!law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized rn writing from the <br /> Building Officia!before being authorized under any circumstance. I am the owner,or I am authorized by the owner of this property to perto�m fhe work for which application is made, <br /> and 1 comply with the Sfate Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Evereft Official Use Only <br /> ` �uc 2y 2c�►� �T ��� �- �� <br /> Owne uthori d Agent Signature Dat (Revised 5/20/?_016) <br />