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PERMIT APPLICATION <br /> BUILDINC ECHANICAL / PLUMBING /SIGN 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.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDR SS: � t r. � PROPERTY TAX#: �' - )� Q �,'�/^'�� �� <br /> `7 t� <�(i � <br /> LEGAL for new nstruction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: � �(G(L� C TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReeT �Z L �('�C�ll <br /> CITY STATE l� � ZIP `./����7 <br /> � <br /> OWNER PHONE: � x� r' �— -��(��` ��S` � OWNER EMAIL: (� Gt(jfQ� �,� + � f�> ,,� �?// <br /> CONTRACTOR NAME; �- !`Ut C� l:c-z r C_., ( <br /> CONTRACTOR ADDRESS: sTReer <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): (.�/� �`'1 N I` CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): � � � <br /> PRIMARY CONTACT: OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �r .� ' -- ��S F� <br /> ��)L�S�t�fG� �f,'�G ���i���� CONTACT EMAIL.' ° ��iL���Ut'l��tli;� y� " <br /> �L : t'�,�i 1 Lr <br /> BUILDING PERMIT APPLIC TION <br /> Existing Use of Building: >l�_� Contract Price of Work: $ �< < �� <br /> Proposed Use of Building: y .,�_ Heat Source: ❑Gas lectric ❑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 /> (�'{]��J� �y� c� �/ �� . ,,. > .r,�v �^�wt�/Nc�p�;� j�,,�l�r. ��1/'Lcy �j /�r'����2 ���„�(�.;,�. <br /> 1 lL ��V � ��'�II� ✓��I�J � ��V4L� I�UL! � <br /> � � l � ���.�� <br /> ,j,� q� //�� �r�u�;>c� � z� <br /> �'��l�iV�M� �I�('iJ 1�'6�'uE`d 4' U.:�t����l1�I L� vr('��t°��� �t�N-: .'LK� i7r)u�"L�S <br /> ���y <br /> ASSOCIATED BUILDING PERMIT#(if applicable): `✓'r��t i v v�� '�l,�;�.- <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPL CATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixfures #of List of Fixtures #of Lisf of Fixtures #�f 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& 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 /> Number of Heads <br /> ACKNOWLEDGEMENT:1 have reviewed this application and confirm the information contained herein is true and correct. Work done pu�suant 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 therefrom.Deviations must first be authorized in writing from the <br /> Building O(ficial before being authorized under any circumstance.1 am the owner, or I am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Cqnfractors Laty 27 RCW and 296.200A WAC. <br /> City of Everett OKicial Use On/y <br /> �. /j PE MIT <br /> G�;� : �l �q ���� ��t5 - <br /> Owne ,,4ut rized A nt nature Date (Revised 10/?2/2015) �, L <br />