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���Mi-r AP�LicATaonl� <br /> �111LDING / IVIECHANICAL/ PLUM�IIVC� /SIGN 1 SPRINKLER/ DEfVIOLITION <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!nk Only Please) PROJECT SITE INFORMIA'TIORI <br /> PROJECT SITE ADDRESS: (O�7 �� L"tJ2�� IZGt �� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �/' c7�� V � TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReeT G' � ,� �1=-�r�l) ��'. <br /> \ ' R Q <br /> � CITY � � STATE � � ZIP <br /> OWNER PHONE: L rj �, (� OWNER EMAIL: � � Q � .. ��J <br /> CONTRACTOR NAME: � � t� -1t,6 11 � <br /> CONTRACTOR ADDRESS: sTReer Q , 1"s�I Cr � G <br /> CITY 2� STATE � ZIP � <br /> CONTRACTOR PHONE: I j Y ' CONTRACTOR EMAIL: t� Y` rr C • �j� �( �,O/� <br /> CONTRACTOR LICENSE#(REQUIRED): ��Gl �� ��l.�t. CITY OF EVERETT BUSINESS LICENSE#(REQUIRED• <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ � � � <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family�#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodei ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ;n Sy�.G4f� f�anc-� u.�s�, �t n k-� �r►d L� io�.c-f�e-� ���l� �c�► Sr'n� 1 c��-,� S�n <br /> �;"_� � n- `� <br /> �►�u��'X�' v� I'F,-Icr,vr.h;�/ !cH' , '�m'rn �r;r��� �`escU� �[nor �En 1� le . �ib-r►� �7�i�' �Ps� <br /> ASSOCIATED BUILDING PERMIT#(if applicable):�'� ��h �� <br /> MECHANICAL PERMIT APPLICATION LUMBIN PERMIT APPLICATION <br /> Type of Project: _New Addn _Alteration _Repair Type of Pro� ew _Addn _Alteration _Repair <br /> #of List of Fixtures #�f List of Fixtures #of List of Fixfures #�f Lisf of Fixtures <br /> Fixtures Fixtures Fixtures 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 Fioor 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: �L� <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <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 deviafions therefrom.Deviations must first be authorized in writing from the <br /> Building O�cial before being authorized under any circumstance.l am the owner,or I am authorized by the owner of this property to perForm fhe 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 O�cial Use Only <br /> PERMIT I T� I <br /> � . �vGc� L. 1t�- i? �l�? � l � u t <br /> Owner/A orized Agent Signatur Date (Revised 9/2 /2016) i/ <br /> Y <br />