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PERMIT APPLICATI <br /> BUILDI�/ MECHANICAL/ PLUMBING / SIG . PRINKLER/~DF•hIIOLITION <br /> CITY OF EVERETT PERMIT SERVICE��'�=•- -_— <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 /> (Blue or�lack Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: �((; - / - �-(�. PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER YVAME: TENANT NAME(If Commercial):�� � �iw;� j� i�a fi�.,.� <br /> OWNER MAILING ADDRESS: sTReeT `7�� f <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: � " —' � SE �J •�/�"� J��'? �'{J C1Y � <br /> CONTRACTOR ADDRESS: srReEr Z;�-(� ,�I� rtl/" �- �� <br /> ciTv � i�`�,�J��j 1 I/3- C:� STATE �C./! f ZIP � ���%�1 <br /> _ . . . „ .j , <br /> CONTRACTOR PHONE: ��Li'L%- �f�� � CONTRACTOR EMAIL: F�� �,r'i'C'-��"L"`�-!U�' =' �"' l G1 r-!.�Z=�'-V - <br /> CONTRACTOR LICENSE#(REQUIRED): '� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): � <br /> _ _ _ _ _ __ <br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <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 /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign Sprinkler ❑Demolition hange of Use <br /> DESCRIPTION OF WORK: �' <br /> ���1�i.!�X;�� c;=��. �IJC.:``�/ '��L� ��j� �,r�( .�" /�'_-l'� <br /> � �, <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 #�f List of Fixtures #�f List of Fixtures #°f List of Fixtures <br /> Fixtures Fi�ctures 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 /> SPR�I�F1(!_ER/SUPPRESSION SYSTEM <br /> - � �, Number of Heads <br /> ACKNOWLEDGEME.NT.I have reviewed this application and confirm the information contained herern is true and correct. Work done pursuant to this permit must comply with <br /> current federal,state,and local law. The granting of a permif 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.l am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 compry�vith the State Cor�tr tors Law 18.27 RCW and 296.200A WAC. <br /> � 1 � City of Everett Official Use On/y <br /> � i PER IT <br /> ',,` / ��� nL _ � ��% � C% I � t2 O <br /> Owner/Autpiorized Agent� ignature Date (Revised 5/20/2016) <br /> '/� <br />