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PERMIT APPLICATION� <br /> BUILDING / MECHANICAL/PLUMBING/SIGN /SPRINKLER/ 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;Onlyf�te�se) _ ,�!�tdJEC'C S1T INFORMATION, y � ; <br /> �. -,�.. <br /> PROJECT SITE ADDRESS: !/ O � PROPERTY TAX#: � � � <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> � , <br /> ;CO N,TACT,I NFORMATION <br /> OWNER NAME: ; TENAN NAME(If Commercial): '� . <br /> OWNER MAILING ADDRESS: sTReer �,Cj A � � )L�"�' <br /> CITY STATE �/�J ZIP <br /> OWNER PHONE: � �-� -•� ` OWNER EMAIL: " <br /> CONTRACTOR NAME: �� h..C. .'_"' ,_ , " `Gt � <br /> CONTRACTOR ADDRESS: srReer q„ � <br /> CITY STATE � ZIP O <br /> CONTRACTOR PHONE: �� -� � CONTRACTOR EMAIL: {n^�.�./�IZ.G� �- �, � <br /> CONTRACTOR LICENSE#(REC2UIRED): (� j�,� � Q CITY OF EVERETT BUSINESS LICENSE#( UI D)t C <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 'ZG�.►- 'Z�'–d.j'�t,.� <br /> �p,7C�.,G, �„�J'� CONTACT EMAIL: � � � <br /> i.' �"= BU14D�NG;P�#��MIT APPLI�A'TION,x,,;r�.,j f u <br /> > <br /> Existing Use of Building: (,6Yv�/r..Q('� Contract Price of Work:$ ()O <br /> Proposed Use of Buildin : a`q,� �' � e ourc . ❑Gas ❑Electric ❑Other <br /> Buildin T pe: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. Si n rinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: �v�5 u �„ �+a,�„r �t�, U.,�Q �L �.�J�ir �� .. <br /> ��,Q ���6�,t�.n�.t���O.� G��. '�..3 O �S�v'�J?,S O"'� �R ��i.�t. — C...I�� 0►-�� <br /> �f i J �li�.�- <br /> ASSOCIATED BUILDING PER T# if a � ble : <br /> � � � <br /> MECHANICAL PERMYTAP,Pl�iG,AT10N = u "_"; , n� , ,;� ?.F P'L�J,'M,BIN� f��RMIT APP�,i�A'f'ION : ;;:., , <br /> Type of Project: _New Addn Alteration Repair Type of Project: New _Addn _Alteration Repair <br /> #of List of Fixtures #°f List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fi�ures <br /> A/C–Air Handlin Units Heat Pump Toilet Backflow Preventer(Inside Bld ) <br /> Forced Air S stems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinkin Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Ran e Ductin 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 $YSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.�l 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.1 am the owner,or 1 am authoriied 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 /> PERMIT# <br /> � �,, � cS I Q '001 , <br /> Owner/A thorized Agent Signature Date (Revised 9/23/2016) <br /> 1I� <br />