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�E�nni�A�PLoc�riorJ� <br /> �UILDING / MECFIANICAL/ PLUM�ING /SIGN /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)everettep everettwa.gov� www.everettwa.gov/permits <br /> (�lue or�lack Ink Only Please) PR�JECT SITE INF MA°T Old <br /> PROJECT SITE ADDRESS: `� S.�✓. �lO�J'r/� �la Pij/oL /- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision L No. (attach copy of long legal description) <br /> CONTACT IN�ORMATION <br /> OWNER NAME: pf �j - rlr' SSOa f � TENANT NAME(If Commercial): ,y <br /> OWNER MAILING ADDRESS; s-rREeT � D O 3 <br /> arr C (/k.+P� STATE ziP � <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME�� h G <br /> CONTRACTOR ADDRESS: srReer ` 2, � r/�i <br /> CITY �/� � STATE ZIP ��J�"+ � <br /> CONTRACTOR PHONE: �j � •('j YO I CONTRACTOR EMAIL: P p Ifl r� C 1 I y ,�/' <br /> CONTRACTOR LICENSE#(REQUIRED)�`T� � q� CITY OF EVERETT BUSINESS LICENSE#(REQU D): <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR �THER(Piease Specify) !� �'�. <br /> CONTACT N ME: CONTACT PHONE: � � �3 l � �'G �' <br /> � �O`h�/.�fif 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 ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:��� c F'Q`. � /�✓ � .,to Q ,� <br /> " �st.K j h� �i. 4 <br /> ASSOCIATED BUILDING PERMIT#(if applicable):� f�d (� `�0 2 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLIC/ATION <br /> Type of Project: _New Addn Alteration Repair Type of Project: _New Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixfures #of List of Fixtures #of List of Fixtures <br /> Fixfures 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&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 /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No. of Heads <br /> ACKNOWLEDGEMENT.�I have reviewed is 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 ranting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building O�ial before being authorize under any circumstance.l am the owner,or/am authorized by the owner of this property to pertorm the work for which application is made, <br /> and I com with the Sfafe C tract s Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> `�D _� � PER T# �n_ � � �� <br /> e—� <br /> wner/Aut ed gent Sign e Date (Revised 9/23/2016) <br />