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PERMIT APPLICATIO�� �� <br /> BUILDINc� I ��IIECHANICAL/ PLUMBING /SIGN / SNRINKLER/ 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� www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: C�� �jd»� � . Z � ,�� PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �, CO C lCS C. TENANT NAME(If Commercial): E s PS. <br /> OWNER MAILING ADDRESS: sTReer N�p S�", s � <br /> CITY v�.?�����' STATE � ZIP �a OI <br /> OWNER PHONE: �-�j 2,$ - a�'j� - �Raq OWNER EMAIL: bpb bQ e,rG�/�Q,nS.LO�rv� <br /> CONTRACTOR NAME: �'j=�.,,�' <br /> CONTRACTOR ADDRESS: sTReer � <br /> CITY STATE <br /> 21P <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: - ----_ <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(RE RED): � <br /> PRIMARY CONTACT: kfl OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: y,2 S - aS o� �(9q,09 <br /> +�ej �jQue•(� CONTACTEMAIL: b�b bauece.�anS•�-OYV� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Buildin : Contract Price of Work:$ � - O <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 Pro ect: ❑New ❑Addition ❑Remodel ❑Repair �T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ae��ac.a pa�-t�al w d�\�stY2"' K �o-r ' � ��,R� was p�cv�usly cc*�,uteP. <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 #of <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet , Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinaf <br /> Gas Piping � Boiler Lavatory(Wash Basin) ';, 6rinking 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 Hdokups Other. Clothes Washer oa' / Medical Gas <br /> Ran e Hood , Water Heater Other: <br /> Exhaust Farf Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water 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 the�efrom.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 app/ication 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 /> PE I <br /> alaZlr7 ;� �. � -��2-- , <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) �'7 � <br /> C� <br />