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PERMIT APPLICATION <br /> BUILDIN� IECHANICAL/ PLUMBING /SIGN �RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVIC== <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 Snk Only Please}- PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: � 2 g U � PROPERTY TAX#: �j �j <br /> LEGAL for new construction: Short Plat/subdivision���A Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: F�'�j"� $A�'Tl`�T G�IA H P l —p��ENANT NAME(If Commercial): �„ �Y}.��Iz ��j� <br /> OWNER MAILING ADDRESS: srraeer <br /> CITY �,v�� �T STATE ZIP q <br /> OWNER PHONE: q-Z'rJ' 'rJc�I —O OWNER EMAIL: , <br /> CONTRACTOR NAM[ <br /> CONTRACTOR ADDRESS: s�e� <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUI E ): <br /> PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR f� OTHER(Please Specify) �c 1 -r <br /> CONTACT NAME: �-YFt ';'iT t.`" � HO (��ZGh��j CONTACT PHONE: ����?, 1 ��-- Z�G� <br /> �j(Z'��U �aW� CONTACT EMAIL: bt(�1TTGtY� rnw���haarc . orr�r� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: " �_ ��G L Contract Price of Work: 5 Z- � OQ�•00 e �yv� � <br /> Pro osed Use of Building: Fj—D � — '�T�l(�L. Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Ty e: ❑SFR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Famil -#of Units: �Commercial ❑Industrial <br /> T e of Project: ❑New ❑Addition ❑Remodel ❑Re air ]�T.I. ❑Sign ❑S rinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: �N���1�� ��,,,op��,�W! ���,�,1) 1„)i II Mo A I� -t�� ��CISTI�lU 5Pl°�G� <br /> F� � �,8G3 s���T. P 6Nfi-A,� ��F� W 1TH I NT��to�- ��Lt"11'1QIJ5� �I�.l PMEIJC-� �I U1s}-�ES, <br /> L 1(s�-t�lu� � �Pl l�M$�p N ZD. <br /> ASSOCIATED BUILDING PERMIT# if a licable : <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 #�f List of Fixtures #of List of Fixfures #of List of Fixfures <br /> Fintures Fixtures Fi�rtures Fixtures <br /> 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 8�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 /> Chemical or Water No. of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the informafion 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 therefiom.Deviations must fi�st be authorized in writing from the <br /> Building O�cial before being authorized under any circumstance.1 am the owner,or 1 am authorized by the owner of fhis property to perform the work for which application is made, <br /> and!comply with fhe State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett O�cial Use Only <br /> PERMIT# <br /> 1 <br /> Owner/Authorized Agent S' ature� Date (Revised 9/23/2016) <br /> \ 1 � � <br />