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PERMIT APPLICATION- - <br /> BUILDINU / MECHANICAL / PLUMBING / SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 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: ,Qf 4EIVO/Lc 6C6EX PKLJ j/ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: STDe/"nJ-lpvc TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /000 ,&&V r j�/t/ZICLt) u� / <br /> CITY STATE �! ZIP 111n.0- <br /> .+ <br /> OWNER PHONE S- yid - (,qqy OWNER EMAIL: �'� /�'�Sflt'.'►�St`�C�Cp�f- �`)'ri <br /> CONTRACTOR NAME: RIZE SYSTEIV <br /> CONTRACTOR ADDRESS: STREET �wL, Alt E <br /> r� <br /> CITY '� ,!� &' STATEVlq ZIP � y� <br /> CONTRACTOR PHONE: A5 - g- j CONTRACTOR EMAIL: /�s��/���S�t���+�'✓✓� �'�'' <br /> CONTRACTOR LICENSE#(REQUIRED): ?'f!j'Nf513e-. 7- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 3S jZ <br /> PRIMARY CONTACT: ❑ OWNER XCONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: ;EFF Sri IT14 CONTACT PHONE: <br /> CONTACT EMAIL: 650i1 ifs/!!,�p•H <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 575 tZI Contract Price of Work: $ <br /> Proposed Use of Building: 1Y7ta,i141,znc tuzleu;. iZ Heat Source: ❑Gas El 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: TNLs�kY57lrlX SPfzlrJL'L�� SYSIGM TJ <br /> fiG��s"�w>»ri'r7L'T!•if y1)t:W MirG�AwtCrlL��u3'I��.�� <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 #of List of Fixtures #of List 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 IShower 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.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. I am the owner,or/am authorized 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 /> r City of Everett Official Use Only <br /> q PERMIT <br /> Owner/Authorized Agent Signature IP Date (Revised 5/20/2 16) <br />