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PERMIT APPLICATION Ir <br /> BUILDIN��IIECHANICAL/ PLUMBING /SIGN /arRINKLER/ 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 /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS��;� �YT �.52v c PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: y�is�c,�l� �✓G�.��"Zs; i��.� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReer <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: �� �,���v�c`�.�v�--7 Z�yr���- —�-�Q.� J��"4,�w�d.� (�lf�L �• - 1 <br /> CONTRACTORADDRESS: sTRee-r ��' ' t�--L:�-=r:�—�{..�--4'e� <br /> CITY /�/�'�j� STATE LL/�- ZIP y ��-y� <br /> CONTRACTOR PHONE: l 3 (oo) �yG � 7c,!(�Z- CONTRACTOR EMAIL: iti`�-v [� /Z�i i=� /z� . C'�>i�Y7 <br /> CONTRACTOR LICENSE#(REQUIRED): - - CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ''�r�� <br /> PRIMARY CONTACT: ❑OWNER ONTRACTOR ❑OTHER(Please Specify) f)[=��1 ��/ <br /> CONTACT NAME: CONTACT PHONE: �9`2� - �i:� ;� -,3 � S �� <br /> I�� �-c7��in.�beJ,:.' ' <-=�-i'Y[S�.:� CONTACT EMAIL: i,v%`-�- E� �2/�i F"./z� � [-�iv1 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Fi��'�? /a�-L=� Contract Price of Work:$ (� s�'Z-S� <br /> Proposed Use of Building: �' Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex C�3�Aulti-Family�k 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 /> /Z.c:�r4 i,L �- c.����✓�-��" ��jZ r S I`��..ti;',t [c �c.'- S > STL-7y7 �ti i=� �S 7ia. C `-f f t_�. k <br /> �.c� /"i'.'�v�-i 3 /� <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 Lisi 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&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Ciothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> � �j Number of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this 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 granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Officia!before being authorized under any circumstance.1 am the owner,or I am authorized by the owner of this property to pertorm the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# � <br /> ,�"� � z�z���� �Z' �� -- <br /> OwnerlAuthorized Agent Signature Date T— (Revised 10/12/2015) ��,1/ �' 1 <br /> `,� ' j � (f � <br /> ��� . 2 <br />