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�s <br /> t PERMIT APPLICATIO <br /> BUILDIN�MECHANICAL/ PLUMBING / SIGN / PRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)�A25-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: � �'� I�j K 1� �ti�f �� PROPERTY TAX#: O�-^�i�{`������i�� <br /> � <br /> LEGAL for new construction: Short PlaUsubdivision 11✓�=��1 � .���^ Lot No. �-d (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ?b!�-� S(. ��� � ���,���� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReer f O�s I j ��TN�i U� �� <br /> CIN r� ,(� � STATE l��'�� ZIP ���O� <br /> OWNER PHONE: "7� ' �`'I�7 "LI p�7� OWNER EMAIL: <br /> CONTRACTOR NAME; /✓��AAJ�.I" ��1U-�c.(p �,/Li�'Gl�l <br /> CONTRACTOR ADDRESS: srReeT �`2-�'( �g 2Nr J� �'1i1/ <br /> CI�iY �[)��'"� STATE �/v^ ZIP �O 6( Z <br /> CONTRACTOR PHONE: �2S —�'��l~�(,�G..O CONTRACTOR EMAIL: gr/NC-+C!'��N/��i�.' �,eQ/��N��M <br /> CONTRACTOR LICENSE#(REqUIRE�): jL{!�/���p(;�3 JG CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 32h�L <br /> PRIMARY CONTACT: ❑OWNER ,.�ONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: �-����/ L�h+� CONTACT PHONE: uZS�'���•—�(�j('�Cj <br /> CONTACT EMAIL: �nJP�,fl/J('��..�'i/�iLS'"�- f�/`'`� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ �(,���� <br /> Proposed Use of Building: Heat Source: ❑Gas ,�lectric ❑Other <br /> Building Type: FR-Detached C7SFR-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: <br /> l'�✓33�LL�N� f�' N�-r,v Qi.�t'�I�r�"yS i;��!�` ���/!� <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 List of Fixtures #of ��st of Fixtures #of List of Fixtures <br /> Fixtures F'ix s Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <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/SUPPRES�SION SYSTEM <br /> Chemical or Water No. of Heads <br /> ACKNOWLEDGEMENT:1 have reviewed fhis 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 local law. The granting 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 I am authorized by the owner of this property to perform the work for which application is made, <br /> and l comply with the St Contr tors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Officia!Use Only <br /> PER�11�# _ � <br /> ll�Lo-l., v� � <br /> OwnerlAuthorize Agen i ature Date (Revised 9/23/2016J <br />