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PERMIT APPLICATION <br /> BUlLDING /MECHANICAL/ PLUMBING I SIGN !SPRINKLER 1 DEMOLITION ' <br /> CITY OF EVERE�T PERMIT SERVICES � <br /> 3200 CFDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� �w�nv.everettwa.gov/permits <br /> PROJECT SITE INFORMATION � <br /> PROJECT SITE ADQ�2 SS: PROPERTY TAX#: � <br /> �.�E � -r � w�� Oo3�l �oc�oa � I <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) ', <br /> CONTACT INFORMATION <br /> OWNER NAME: p U(�1J� �j'r� L�i TENANT NAME(If Commercial): ��� p �(5 ' <br /> OWNER MAILING ADDRESS: sTReEr ( gZ L-PcVG� C DDW�� ' <br /> � <br /> i <br /> cirv � N srnTE W zir� Z � i <br /> OWNER PHONE: K�S' ' �S3"� OWNER EMAIL: U N�'�� C,F� �7 �CC� ; <br /> CONTRACTOR NAME: S (�j��,`�Q I <br /> CONTRACTOR ADDRESS: sTReET g 1� � (J� <br /> i <br /> CITY ,��� STATE � ZIP �'..-.. <br /> CONTRACTOR PHONE: S• � CONTRACTOR EMAIL: ' Sr(,�(7„� <br /> CONTRACTOR LICENSE#(REQUIRED): N � �j5 C1TY OF EVERETT BUSINESS LICENSE#(REQUI D): <br /> PRIMARY CONTACT: ❑OWNER ONTRACTOR ❑OTHER(Pfease Specify) <br /> CONTACT NAME: �� ���� CONTACT PHONE: 2 ,?) S .,� `�-S , .y" <br /> CONTACT EMAIL: H� ��C :�"I �/ 'rt <br /> C/� <br /> ; BUILDING PERMIT APPLICATION ;� ;' ` <br /> Existing Use of Building. (��U� � ��r/ Contract Price of Work:,$ �� � � <br /> Proposed Use of Building: Heat Source: ❑Gas ',DElectric ❑O�her j <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Dupiex ❑Multi-Family-#of Units: ❑Com ercial ❑Industrial � <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair T.I. ❑Si n ❑S rinkler ❑ molition Change of Use <br /> DESCRIP710N OF WORK: ' <br /> l�R��F I r-����02 ��-f' �P�-S r�'r ^JGw D1ZES5iNl� �,�.�5 l�l� <br /> �UN�N`o GGILr% �-n a,�5.I NS�c/�-�— �,„� 3 Z „,��5, <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration Repair Type of ProjecL• _New _Addn _Alteration _Repair <br /> #of Lisf of Fixtures #of Lrst of Fixtures #of Lisf of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures 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 /> _ <br /> SPRINKLER/SUPPRESS�ON SYSTEM ' <br /> �; <br /> Number of Heads i� <br /> ACKNOWLEDGEMENT:1 have reviewed this application and confirm the information confained herein is true and cor�ect.Wo�k done pursuant to this permit musf comply with <br /> current federal,state.and locallaw.The granting of a permit onty authorizes approved work and no deviations theref�om.Deviations must first he authorized rn w�iting irom the i� <br /> Building Olfrcial before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work fo�which application rs made, ;: <br /> and I comply with the State Contractors Law?8.27 RCW and 296.7.o0Fl WAC. <br /> __ City of Everett Offrcial Use Only <br /> �� PERMIT# - <br /> z/ /�" ����'7 , ' :..��i <br /> l J 1 <br /> Owner/Authorized Agent Signature' D te (Revised 10/12/2015) �' �� Ij <br /> � e <br /> � <br /> Z - <br />