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PERMIT APPLICATION <br /> BUILDING 1 MECHANICAL/ PLUMBING I SIGN I 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 Only Please) PROJECT SITE INFORMATION <br /> �-- <br /> PROJECT SITE ADDRESS: '�� ��' �;; �_�/'?;/<->�'�;• � PROPERTY TAX#: Z��I�r � �`��'J�I I ���O � <br /> LEGAL for rew construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ��/�''�/�;� ��� fi:�. � ``�}`�' �'1�__ TENANT NAME(If Commercial): �j��.,'C� �y� ��r -% <br /> OWNER MAILING ADDRESS: sTReer � I � � �� <br /> C�c.-� �c- <br /> ciTv i����./<' .�f��i ."_� srnTE \, �`C.c ziP � ``�; ��>� <br /> OWNER PHONE: L Z �-�- ��r ,��'37 OWNER EMAIL: V1��C�-� �-C �� ,� s /� ��U w'7 <br /> CONTRACTOR NAME; - �/� '--I-��c°_�1'� � I�1 �� <br /> � <br /> CONTRACTOR ADDRESS: sTReer �,�� I�./�'t M�� �'t,(s) �iiY �_,� '`� <br /> CIN - ��l� (�'J STATE ����C-L ZIP ��� �!'4� <br /> __.-- <br /> CONTRACTOR PHONE: �+Z;j 7�-' f (� E� CONTRACTOR EMAIL � ,.<<,,. '1"'� `� �` ' ' � <br /> >., ���� �; - ,��. 7.., 2;�;. f f�;,r.,l... <br /> CON7RACTOR LICENSE#(REQUIRED): � ��. �G CITY OF EVERETT BUSWESS LICENSE�t(REQUIRE :��(J��� �' <br /> PRIMARY CONTACT: ❑OWNER I�CONTRACTOR ❑OTHER{Please Specify) <br /> CONTACTNAME: CONTACTPHONE: Jr ff, . -;�,�,-� ,_ �,�, �,- <br /> �r�l,)C'r-O L���,,r� I`Gt.l�Y��� CONTACT EMAIL: �TG"l�- �C�� I�r ���r.r ���r �;�'C+- �'� �z e.��Yd��7 �_G�t.e�a <br /> BUILDING PERMIT APPLICATION ,� , <br /> Existin Use of Buildin : JGc-��a Contract Price of Work:,$ ' � ���--��,—� <br /> Proposed Use of Buildin : Heat Source: ❑Gas Electric ❑OtFier <br /> Buildin T e: ❑SFR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Famil -#of Units: �'Cornmercial ❑Industrial <br /> Type of Pro'ect: ❑New ❑Addition ❑Remodel Re air ❑T.I. ❑Sign ❑Sprinkler DDeE�ofition ❑Change of Use ; <br /> DESCRIPTION OF WORK: <br /> 2r'�'C.,.0 t�.J �C'G�(�`S`y f-flw E_,n,' ��1��1P WIV I�, ��C-'��✓` �<:..=��1 1 t�" �S <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 Frxtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixfures Fixtures <br /> A/C—Air Handling Units 1 Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air S stems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavato Wash Basin) Drinking Fountain <br /> Water Heater Refri eration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hooku s Other. Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink Service/Bar/Mo /etc. Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No. of Heads <br /> ACKNOWLEDGEMENT:1 have�eviewed this application and conlrrm the in(oimation contained herein is true and coirect. Work done pursuant to this permit must comply with <br /> cunent federal,state,and local faw.The granting o/a permit only aufhorizes approved work and no deviations there(rom.Deviations must first be authorized in writiny(rom the <br /> euildiny O(ficia/belore being��uthorized under any ciroumstance.I am the owner,nr I am authorized by the owner o(this property to pertorm fhe work for which application is made, <br /> and 1 comply with the Stafeyf;ontractors Law 18.27 RCW and 296.200A WAC. <br /> ✓� <br /> City of Everett Oflicial Use Only <br /> �' :9° <br /> � :1 � � ` ,: ��n��``.;�'� �— z��-17 ��' T�� —�S� <br /> Owrfer/Authorized Agent Signature Date (Revised 9/23/20i6) <br /> G'" �� � <br /> � <br />