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I III PERMIT APPLtCAT10�'I <br /> BUiLDlNb TMECHANtCAL/PLUMBING i SIGN t SPRINKLER i DEMOLITION <br /> CITY OF EVERETT PERMIT SERtIiCES • � <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 /> (B1ue ar Black Ink Oniy Please) PROJECT SITE[AlFORMATION � <br /> PROJECT SITE ADQRESS: 7 veJ(' .}�- � PROPER7Y 7AX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (affach copy of long legai description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ,J TENANT NAME(if Commercial): "� <br /> OWNER MAILlNG ADDRESS: sixeer � i-h <br /> CffY VV�11��1 ` STATE W/"t 7JP Q 7 <br /> 01fVNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: �T 1"� \J L C�f'S <br /> CQNTRACTOR ADDRESS: sra�r �� 1 .- � �- � 3 <br /> CfTY � STATE ZIP 6� <br /> CONTRACTOR PHONE: � , 3 � CQNTRACTOR EMAIL: `j L • O <br /> CONTRAGTOR L.ICENSE#(REQUIRED): � � Q CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):DJ�S �C3 <br /> PR�MARY CONTACT: ❑OWNER ONTRACTOR ❑OTHER(Ptease Specify) <br /> CONTACT NAME: ��K �����`,eS CONTACT PHONE: �Z'T. ��j� $�6 � <br /> CONTACT EMAIL: L ����-�j. �� � <br /> BUILDlNG PERMIT APP!lCATION <br /> F�cisting Use of Building: Qj'Y) Contract Price of Work:$ �1 <br /> Proposed l7se of Building: h� /� Heat Source: ❑Gas ❑Electric ❑Other <br /> Suilding Type: ❑SFR-Detached ❑SFR-Attached ❑Dupfex ❑Multi-Family�#of Units: ommercial ❑Industrial <br /> Type of Project ❑New �Addition ❑Remodel ❑Repair ❑T.I. ign ❑Sprinkier ❑Demoli#ion ❑Chan e of Use <br /> DESCRIPTION OF WORK: <br /> t rls-t�.l�� c�ne.. LEL7 �ct�i, '�tgr1 <br /> ASSOCIATED BUILDING PERMIT#(if a plicable): <br /> MECHANICAL PERMiT APPLICATION PLUMBING PERMIT APPLICAT[ON <br /> Type of Project: _New Addn Atteration _Repair Type of Project: _New Addn Aiteration _Repair <br /> Fixfures �st of Frxtures ��U� Lisf of�xtures F��°f� L1st of Fixtures Fixtures ust of Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg} <br /> Forced Air Systems Uni#Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin} Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Waod Stove Kitchen Sink&Disposa[ Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clathes Dryer Hookups Other. Clothes Washer Medical Gas <br /> Range Hood Water Heater Other. <br /> F�chaust Fan Sink(SeroicelBar/Mop/etc.) Ofher: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.-t have reviewed this application and confirm the informa6on confained 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 tkerefrom.Deviations must firsE be autho�rzed in wrr�ing fram the <br /> Buifding O�cia!before being authorized under any circumstance.l am the owner,or l am authorized by the owner of this property to perform fhe work for which application is made, <br /> and/comp/y with fhe State Contractors Law 98.27 RCW and 296 200A WAC. . <br /> Cify of Everett Official Use On/y <br /> �. t P T��� t '�'QO S <br /> Own r/Autho ized Agent gnat e Date (Revised 9/2312015) � <br /> 1 <br /> � �. <br />