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PERMIT APPLICATIO�� <br /> BUILDINu��dECHANICAL/ PLUMBING /SIGN � J�RINKLER/ DEMOLITION <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.govlpermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:�L) S 1/� , � �.7y�.j�}- Mc'�4I V�G� ` ��; PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): =ln'L�;'�y'�," � <br /> OWNER MAILING ADDRESS: srnEET 1—�' S V.� , �-t,�j+2y'�--�-�— i"`�� �'�C'� ' �� <br /> CITY LZV�' � `- STATE "'`� ) ZIP �`�-tJ�� <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: �A� O N� C�% <br /> CONTRACTOR ADDRESS: sTReeT ?j���; S 3 ��C'�.C- �C� �i�i S <br /> �_��� � � <br /> cm +L ���'�i�� s rr,i t j/v� ziP � i:L 5 <br /> CONTRACTOR PHONE�'-S'���G'(�{2-�?j�+���' CONTRACTOR EMAIL- G��t�l1�'-CU'` fcAJ �ti�lG� � <br /> CONTRACTOR LICENSE#(REQUIRED): � C�►��'lUC_G� 7�1 O'� CITY OF EVERETT BUSINESS LICENSE#(REQ ED): �\ <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHOAtE: iy��j 1 C�t{-Z—?j�j'`.l� <br /> 17.� _ �.��G�_ CONTACT EMAIL: C�t'�t,`ti1C-�1;ti^ � ` 't.i'l�� C��"� <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: <br /> � <br /> �-r�-�;tr.,�� s z� �— ��.c���!�C�v�`-� �'��rs-�1�z--� I�tj-z� �S �"� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #�f List of Fixtures #�f List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fintures 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(5ervice/Bar/Mopletc. Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No. of Heads <br /> ACKNOWLEDGEMENT:1 have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit musf comply with <br /> current federal,state,and local law. The grantrng of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in wnting from the <br /> Building Official before being authorized unde�any circumstance.I am the owner,or I am authorized by the owne�of thrs property to perform the 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 Official Use Only <br /> �� r � �/ (.-�./ ��f� PE T# —� <br /> ( � I <br /> Owner/Author' d Agent Signature Date (Revised 9/23/20 6) <br /> �I� <br />