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PERMIT APPLICATION , '''I <br /> JJ BUILDING J ICHANICAL/PLUMBING /SIGN /St*4KLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> • iiial 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: z--7 `( I I .22-1' ` -. PROPERTY TAX#: 2.9O S—J 700103 20V <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: EVEeerr 1 Ot)S I JL Y'l-} , TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 7 i 0-7 Co[ 1,,,i cz_ �, <br /> cn' v)E—t_ 11 J STATE yV/ ZIP 9 Gn AJ' <br /> OWNER PHONE: OWNER EMAIL: <br /> • <br /> CONTRACTOR NAME: --r--g <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> • <br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: CFZ J 2_013 - 'M j 6,4(4 <br /> 4f1-5J5 kA-<c.__LL_' C., CONTACT EMAIL: (-pry„-ckIt k Q . i `141}' . () <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: "'Y fir- rvi,e_e-E iT Contract Price of Work:$__10\t ,• <br /> Proposed Use of Building: S fj•-rvt. Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: OSFR-Detached ❑SFR-Attached ODuplex QMulti-Family-#of Units: Li ❑Commercial ❑Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel ORepair OTA. OSign OSprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable):-alibi�-''Osei <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New— Addn Alteration _Repair Type of Project: _New _Addn Alteration Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures <br /> NC-Air Handling Units Heat Pump y Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Ly Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Lt Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> 1 Clothes Dryer Hookups Other. Clothes Washer Medical Gas <br /> 8 Range Hood LtWater Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I No.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 Official before being authorized under any circumstance.l am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ` -- PERMIT# <br /> \e_. <br /> Owner/Authorized Agent Signature Date (Revised 9/2 /2016)3 F <br /> \`q �t <br />