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IIIII PERMiT a4PPLICATION IIIIII <br /> �IJILDING � �ECH�►NICd�L/ PLUMBING/SICIV/5'PRINKLER/ DEIVlOLITION <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: b r�WC(, �} PROPERTY TAX#: <br /> LEGAL for new construction: Short Piat/subdivision Lot No. (attach copy of long legal description) <br /> CON7'ACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTRee-r O r� C(, <br /> - CIN �U'GJ�G " STATE �J�"� ZIP����J� <br /> OWNER PHONE: Q ,:,_ OWNER EMAIL: �// � � , <br /> CONTRACTOR NAME; � � d r� � <br /> CONTRACTOR ADDRESS: s-rReer � Q (r <br /> cirr G V E3J�`'" STATE Gi��7 ziP �� <br /> CONTRACTOR PHONE: � — �� CONTRACTOR EMAIL: e,i((0'(' 11 ' �n � 1'Y►G1c ♦CO <br /> CONTRACTOR LICENSE#(REQUIRED): � I��3 j� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNE 'G'1CONTRA T se Specify) : <br /> CONTACT NAME: T PHONE: ���� �-- �� <br /> �S� Q C O� CONTACT EMAIL: Y'd��h �y� � I!� � <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Buiiding: Contract Price of Work:$ ��' S rO C�. ""�' <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric �Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Muiti-Family�#of Units: �Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: o <br /> ���'nl�Z/�2 fil/t�'D � CC��P.✓ Cs.��S i`�n� �G <br /> r�:l�`� ��B�i�o f�is�/f >�� v�_��/ <br /> ASSOCIATED BUILDING PERMIT#(if ap 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 Fixfures #°f List of Fixtures #of List of Fixtures #of Lisf of Fixtures <br /> Fixtures Fi�ctures Fi�ctures Fixfures <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&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/Mopletc.) Other: <br /> SPRINKLER/SUPPRESSIAN 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/oca/law.The granfing of a permit only authorizes approved work and no deviations therefrom.Dediations must first be authorized in writing from the <br /> Building O�cial before being authoriz under any circumstance.I am the owner,or I am authorized by the owner of this properly to perform the work for which application is made, <br /> and I comply with the State C tr rs Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> s ��� Q�� PERMIT�� — �� <br /> s r` <br /> Owner/Authorized e ignature Date (Revised 9/23/2016) <br /> � <br /> Z-, <br />