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�IIIIII' PERMIT APPLICATION ,,I <br /> BUILDlNt�CHANICAL/PLUMBING/SIGN/�PR�NKLER/DEM4LITION <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.govJpermits <br /> (Blue or Black,ink+Dniy Pleasej' . PROJECT gITE INFQRMATION <br /> PROJECT SITE A S • �v�6i(L�..4'rt q, PROPERTY TAX#: Z� 1 � "Z$ � <br /> LEGAL for new const aUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT 1NFORMATI�N <br /> OWNER NAME: Lt 13�T�-( x TENANT NAME(If Commercial): I.y'"Gi•�$ �,f <br /> OWNER MAILING ADDRESS: s�nE�- �'S 2 �-�!�✓L-C��R-EE.� 1,✓�y.. <br /> CI'fY STATE � ZIP �$?/0 p <br /> OWNER PHONE: '25 -- � -►Q S S ( OWNER EMAIL: t�-+ �Tct-�� L�s�-�2--c `1��x . G <br /> CONTRACTOR NAME: ll.�M.�IJ <br /> CONTF2ACTOR ADDRESS: sTRee-r �1,3'ZO S. U 1 <br /> CITY ��O��(.A . STATE `�i�� ZIP l�� O <br /> CONTRACTOR PHONE: ZS 3—¢�JS'—S'Z-S� CONTRACTOR EMAIL: c�•e5.c rt (.yv v•i r ,•� - <br /> CONTRACTOR LICENSE#(REQUIRE �M.l�I� s� CITY OF EVERETT BUSINESS LICENSE#(R�QUIRED): F,��.`Z <br /> PRIMARY CONTACT: ❑OWNER �.CONTRACTOR ❑OTHER(Please Specifyj <br /> CONTACT NAME: �� M/1�.���,y� CONTACT PHONE: 2 S 3 ^ 'Qr'I� —S`Z C'Z <br /> S V�� �"� CONTACT EMAIL: ci•�g c n � �vr ar- <br /> �UILDING;PERRI�AAIT APIPLI�ATIOI� <br /> Existin Use of Building: Contract Price af Work:$ � <br /> Pro osed Use of Buildin : Heat Source: DGas Electric Other <br /> Buildin Type: ❑SFR-Detached �SFR-Attached ❑Duplex ❑Multi-Famil -#of Units: �1 e��al � Dindustrial <br /> Type of Project: ❑New �Addition ❑Remodel ❑Repair �T.1, ign ❑S rinkler ❑Demo itio ,��`an f e of Use��'; ;�> <br /> DESCRIPTION OF WORK: 1��'� /���.C.w.� �wd-� � g tc,+�c�,$,s� � c.Scl �. ,-� ''" r <br /> ` '��,.tl �e�,� f' +� <br /> ,� �a <br /> ASSOCIATED BUILDING PERMIT# if a licable: C`��'p�''� ;' +w,� ���'� �'�'��� <br /> �ECNANICAL PERMIT APPLICATION ' ' PLUMB�NG'PERMIT AP �" " / <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repa'fR� <br /> #of List of Fixtures #oi Lisf of Ffxtures #°f List of Fixtures #of List of Fi�ures <br /> Fixiures Fiictures Fi�ctures Fixtures <br /> A/C—Air liandling Units Heat Pump Toilet Backflow Preventer(Inside Bld <br /> Forced Air Systems Unit Heater Bathtub Urina) <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking�ountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Ran e Ductin Dishwasher Roof Dra9ns <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink Service/Bar/Mop/etc.) Other: <br /> SPRINKL.ER/SUPPR�S$ION SVSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•1 have reviewed this app/ication and confirm the information contained herein is true and correck Work done pursuant to fhis permit must comply with <br /> current federal,state,and local law.The granting of a permit on/y authorizes approved work and no deviations therefrom.Dev/adons must first be authorized in writing irom the <br /> Suilding Ofticial before being authorized under any ciraumstance.I am the owner,or!am author�zed by fhe owner of this properfy to perform the work frir which appllcation is made, <br /> and l comp/y wifh the State Contractors Law 18.27 RCW and 298.200A WAC. <br /> City of Everett�cia!Use Onty <br /> `� PERMIT� �� — ('�/ <br /> 2 �$ � <br /> Owner/Authorize Agent Signature Date (Revised 9/23/2018) <br />