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III I PERMIT APPLICATIOI <br /> BUILDIf��I MECHANICAL/ PLUMBING /SIGN I �RINKLER/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 On1y Please) PROJECT SITE INFORMATION <br /> PROJECT S1TE ADDRESS: Ud� �{�.G��,..X3- � ��/�le Cj�d � PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: O�,L, (,�Q✓I ��� TENANT NAME(If Commercial): Q a <br /> OWNER MAILING ADDRESS: sTReer <br /> CITY � " STATE � ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: � k �Il,� ✓/ (.._,C_L <br /> CONTRACTOR ADDRESS: srRe�r {�p p �[ <br />� CIN -C�.G(,.f"f'` STATE ZIP O� <br /> CONTRACTOR PHONE: �O(o d ( �j� CONTRACTOR EMAIL: ug vyte Crd���� ' P��+yla�' oBiZ <br /> CONTRACTOR LICENSE#(REQUIRED):'P i � P�' OSL S CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): b�OO�I <br /> PRIMARY CONTACT: ❑OWNER �-CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: ;�e�e� o� ��,��� CONTACT PHONE: �j� '�� � �'(�— <br /> �-J / .�/� <br /> CONTACT EMAIL: �`u }�j���-S�' r � ���+ S��i//rii ' "`�'J�Z <br /> BUILDING PERMIT APPLICATION ' <br /> Existing Use of Building: �,�f- Contract Price of Work:$ �Op� <br /> Proposed Use ofBuilding: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family�of Units: I�rCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ��S�at� 2� Q� (` �" �Ce �{.,,.�p t�(j(��.� � ,,�'/�a,- 5�h� <br /> ,�4•p �1�1 � ( <br /> �ldo� �r�tr✓� <br /> ASSOCIATED BUILDING PERMIT#(if applicable: <br /> MECHANICA.L PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn _Aiteration _Repair Type of Project: _New Addn Alteration _Repair <br /> #of /Jst of Fixtures #of Usf of Fixfures #of Lisf of Fixfures �°f list of Fixtures <br /> Fixfures Fixfures Fixfures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(inside Bidg) <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 j Other: ' c� � <br /> Exhaust Fan Sink(Service/BadMop/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 correcf.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 musf 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 fhis 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 /> PERMIT# <br /> �� � � �1 � D f <br /> OwnerlAuthorized Agent Signature Date (Revised 9/23/016) <br />