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PERMIT APPLICATIOiS— <br /> ODILDII iECHANICAL/ PLUMBING /SIGN , JINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blase or (Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: (4 ( 7 5 IN V Q v' / k t?,).?c PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> Ccs ISI(TAC u' IRIWORMATIO'' <br /> OWNER NAME: /1/4-1 a t/5r //1/46(Ci 1-,(5/777-1/2TENANT NAME(If Commercial)nh <br /> OWNER MAILING ADDRESS: STREET ( 6 /7 5-( (v Q V' Z._(L t? <br /> R— <br /> CITY ✓ 7 STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 0/ / -5 CO' V-N `' ' <br /> S <br /> CONTRACTOR ADDRESS: STREET 3(z(/ ( ,/ llw <br /> coy fQ 0 w dd STATE - • ZIP ' `,Z <br /> CONTRACTOR PHONE: i/26"..2(0- Q._ V'CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED)(V(' Co T C. 1 4 CI erteFIVERETT BUSINESS LICENSE#(REQUIRED):L <br /> 6Sq All <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> ,----^ CONTACT EMAIL: <br /> 40 <br /> BUIL®ING PEI'MIT APPLICATTI N <br /> — //''����l <br /> Existing Use of Building: Contract Price of Work:$ lJC) <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric DOther <br /> Building Type: ❑SFR-Detached DSFR-Attached ❑Duplex ❑Multi-Family#of Units: DCommercial 0 Industrial <br /> Type of Project: ❑New DAddition DRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: p .�/� <br /> Ket, e keel L7ac''ftwy Dv'yems' c aG770y r(/i -7111 v2 <br /> ;ASSOCIATED BUILDING PERMIT#(if appIcable): i 1i� _ 0 <br /> MECHANICAL PERMIT APPLICATIONPLUMBING PERMIT APPLICATIO"t <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 List of Fixtures #of List of Fixtures <br /> Fixtures . Fixtures Fixtures Fixtures <br /> NC-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 /> I Clothes Dryer Hookups Other: _ Clothes Washer Medical Gas <br /> I Range Hood _ Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> r - SPRINI LER/ SIUPPESSION SYSTEM 1 <br /> Chemical or Water IF-- No. of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> - - ... <br /> PERMIT# <br /> i\i\.\ -, 7 ta <br /> Owner/Authorized Agent ' ature Date (Revised 9/23/2016) <br />