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III''IIII II PERMIT APPLICATIM <br />BUILD1�iG / 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 1131A. k,lnk Only Please) P,, ROJECTnSITE INFORMATION <br />PROJECT SITE ADDRESS: ;? <br />PROPERTY TAX #: 'Z <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT, INFORMATION <br />OWNER NAME:"( TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET o �(� AN)6 <br />�' , . +,/� <br />CITY asq-ee i E ` STATE `�VAI ZIP Q <br />OWNER PHONE: 2„5. 2-1 Z�, 9424 <br />1,, <br />OWNER EMAIL: a, I't'Ir1t C.e� b 6 comc.2v5 yie+ <br />CONTRACTOR NAME; �d�11IA <br />`` <br />CONTRACTOR ADDRESS: STREET J r3 `j1J r ( iw f�@ �f 6 <br />cay t t t, STATE - ZIP <br />CONTRACTOR PHONE: ITS, 6,01 • g956P <br />CONTRACTOR EMAIL: U 6 wikM� v l ! <br />CONTRACTOR LICENSE #(REQUIRED).4-wiscl Oil D P" <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />PPI 1 eLLD <br />CONTACT PHONE: <br />CONTACT EMAIL: a++ ifs Ea co ck comectS �C <br />BUILDING PERMIT APPLICATION; `, <br />Existing Use of Building: ve:?4 A&- <br />Contract Price of Work: $ <br />Proposed Use of Building: DeNT-I.A1.-- <br />Heat Source: OdGas ❑Electric []Other <br />Building Type: ❑SFR-Detached FR-Attached ❑Duplex ❑Multi -Family-# of Units: ❑Commercial ❑Industrial <br />Type of Project: ❑New ❑Addition Aernodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: J N S° h t-L L. )'P1- � � I p�.,�c� ; � (i? � W I tJ DO'VJ OR6') <br />ASSOCIATED BUILDING PERMIT # if applicable): <br />'MECHANICAL PERMIT APPLICATION,;'` . <br />PLUMBING, PERMIT APPLICATION. <br />Type of Project: _New Addn Alteration Repair <br />Type of Project: _New _Addn _Alteration _Repair <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br />A/C -Air Handling Units <br />Heat Pump <br />Toilet <br />Backflow Preventer (Inside Bldg) <br />Forced Air Systems <br />Unit Heater <br />Bathtub <br />Urinal <br />Gas Piping <br />Boiler <br />Lavatory (Wash Basin) <br />Drinking Fountain <br />Water Heater <br />Refrigeration <br />Shower <br />Floor Drain <br />Gas Fireplace <br />Wood Stove <br />Kitchen Sink & Disposal <br />lGrease Trap <br />Gas Range <br />Ducting <br />Dishwasher <br />Roof Drains <br />Clothes Dryer Hookups <br />Other: <br />Clothes Washer <br />Medical Gas <br />Range Hood <br />Water Heater <br />Other: <br />Exhaust Fan <br />Sink Service/Bar/Mop/etc.) <br />Other: <br />SPRINKLER <br />/' SUPPRESSION,SY$TEM'` <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 Oft ial before being authorized under any circumstance. I am the owner, or I 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 />City of Everett Official Use Only <br />PERMIT <br />(Revised 5/20/2016) 1 <br />