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PERMIT APPLICATION <br /> BUILDINt� I MECHANICAL/PLUMBING /SIGN /,NKINKLER/ 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� w�nnv.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: �pi 20 �j.. PROPERTY TAX#: O�(3�O/_u��/�bT <br /> -L � v� (r/ l «/ V <br /> LEGAL for new construction: Short IaUsu �sion Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: CgjR� G{'��- , da �crC, TENANT NAME(If Commercial): C,-�(�C.- <br /> OWNERMAILINGADDRESS: srnEET 12GfU� �� C'` 1 11�- W S . <br /> CITY Y►�/4,G+ STATE w� ZIP �S ��� <br /> OWNER PHONE: 2VV� Sg�'��p��L OWNER EMAIL: 'LI'Id� . I�CCI� � C�Y�. Cf�1 <br /> CONTRACTOR NAME: gj`(h�Q CQ,hY� V� '�'IV W�t•l/� S . �II1ri � <br /> CONTRACTORADDRESS: srnEEr {�� � �dD <br /> CITY Qj �(i STATE /�T ZIP 8 V <br /> CONTRACTOR PHONE: (0 " 7"7�p � CONTRACTOR EMAIL: CCv�iI'��Jj1I� A� �S(,(fG . GL7Y✓� <br /> CONTRACTOR LICENSE#(REqUIRED): ��, '��� -/�� CITY OF EVERETT BUSINESS LICENSE#{RE�UIREQ): �% L`').� � <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR OTHER(Please Specify) tG <br /> CONTACT NAME: CONTACT PHONE: 2Ljr'3 -��'�'? ��3(�� <br /> N�""""�L w�' �a CONTACT EMAIL: � �Gj ��"A (�� � , �YY� <br /> BUILDING PERMIT APPLICATION <br /> Existin Use of Buildin : rJk�7l Y�C��7 Contract Price of Work:$ � 000, ��7 <br /> Proposed Use of Building: (7 Heat Source: ❑Gas OElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family�k of Units: Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition Remodel ❑Repair ❑T.I. �Sign ❑Sprinkler ODemolition ❑Change of Use <br /> DESCRIPTION OF WORK: , <br /> ,�cl ju�-;� ba� wu.�. �v► bat-�• wa�n�c�.'s reS�r�am `�CA o�ci�n /'c�� s� <br /> C1�.e��c�. <br /> ASSOCIATED BUILDING PERMIT#(if a licable): <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 #of List of Fixtures #°f List of FiaKures <br /> Fixtuies Fixtures Fixtures Fi�rtures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Pipin 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 Ductin Dishwasher Roof Drains <br /> Clothes D er 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 pursuant fo this permit must comply with <br /> current federal,state,and local law. The granting of a permit only authonzes approved work and no deviations therefrom.Deviations must first be authonzed in wnting from the <br /> Building O�cial before being authorized under any circumstance.l am the owner,or 1 am authonzed by the owner of this 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 O�cial Use Only <br /> /�-��-��/� PERMIT# <br /> � � Z-� O 3 <br /> O nerlAut i ed Agent Signature Date (Revised 10/12/2015) <br /> � G <br />