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IgT PERMIT APPLICATION <br /> BUILDINU / MECHANICAL/ PLUMBING / SIGN I SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: Z /4- _,77)•97z .5( PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: /91 AIR TENANT NAME(If Commercial): HQ,i/ g ()')¢/s ) <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 6../icyaL <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: 2,r 5/C" - �75-2 CONTRACTOR EMAIL: 1112kf e. r5 -�� frz� � p,�, , e'"• <br /> CONTRACTOR LICENSE#(REQUIRED)WESC, ()al I(4) a CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):QLj51-65 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR MOTHER(Please Specify) '7>e, T- <br /> CONTACT NAME: CONTACT PHONE: zr <br /> NI I( 641Z/- CA(id;9/,-,16,-( CONTACT EMAIL: Cee„(fC4• kr:64,4` <br /> _ BUILDING PERMIT APPLICATION _ <br /> Existing Use of Building: Contract Price of Work:$ 3 eC- <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑DuplexQ DMulti-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel EIRep40 ❑Sign ❑Sprinkler DDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: /U>T �I 0.5'"yL.Jc.)A.—Ft; Pc!,-/--?•71/-11 C ,`7-s <br /> (Al fiCQ(�' G) LAX�)/,�'if J�'T l I, /� S-- n-•-e_ <br /> I6c'.%%/Lc•. i f i G'�' L. o..�7� <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 List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> 2. 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/ 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 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/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 Everett1Official UseOnly <br /> PERMIT <br /> T1 <br /> i�� / 11 V c2)"6(01 <br /> Owner/Authorized Agent Signature ate (Revised 5/20/2016 <br />