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PERMIT APPLICATION <br />BUILDING / 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: O� ���l�i�i � w <br />PROPERTY TAX #: 0C)4VZ 3�'� �O'�' <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME:�, �� Z�1i \S CW ije c- c�- `Ckt TENANT NAME (If Co(m�mercial): �V\Z �3 <br />OWNER MAILING ADDRESS: sTREETC\0\` � ZZ � coO�,A iv e- ,)\� \A,\\vAe % W - R Z � <br />cl <br />OWNER PHONE: 4-ZS <br />OWNER EMAIL:^� C`-N U,5L,�-e\ess <br />CONTRACTOR NAME <br />CONTRACTOR ADDRESS: STREET O2 l �`� <br />CITY STATE jA ZIP Ol�� <br />CONTRACTOR PHONE: TT- CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQ 1RED):� ` O CITY OF EVERETT BUSINESS LICENSE #(REQUIRED)�,0 <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR N OTHER (Please Specify) Cam(] <br />CONTACT NAME: <br />CONTACT PHONE: Lt.Z j 4 l0 <br />CONTACT EMAIL: 6x \ t �k� aw L 1 <br />BUILDING PERMIT APPLICATIONExistingUse <br />of Building: v� <br />g c e�L'� C� " e�� (IC )C <br />Contract Price of Work:$_ ' <br />Heat Source: ❑Gas DElectric _ EOther \i CG <br />Proposed Use of Building: C- > —\ <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi -Family-# of Units: ®Commercial ❑Industrial <br />Type of Project: ❑New []Addition []Remodel ❑Repair I6T.I. ❑Sign ❑S rinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: L*�W - q�c` ht'��Lv <br />-1'-��� <br />ASSOCIATED BUILDING PERMIT # (if applicable): k) C16, r U\ <br />PLUMBING PERMIT APPLICATION <br />MECHANICAL <br />PERMIT APPLICATION <br />Type of Project: <br />_New _ Addn f Alteration Repair <br />Type of Project: _New _Addn <br />_Alteration _Repair <br /># of <br />ixt res <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fix <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br />A/C -Air Handling Units <br />Heat P p <br />Toilet <br />Backflow Preventer (Inside Bldg) <br />Forced Air Systems <br />LInf 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 />Grease Trap <br />Gas Range <br />Ducting <br />Dishwasher <br />Roof Drains <br />Clothes Dryer ookups <br />Other: <br />Clothes Washer <br />Medical Gas <br />Range H d <br />Water Heater <br />Other: <br />Ett Fan <br />Sink (Service/Bar/Mop/etc.) <br />Other: <br />SPRINKLER <br />/ SUPPRESSION <br />SYSTEM <br />IL <br />Chemical or Water <br />I <br />No. of Heads <br />ACKNOWLEDGEMENT: l 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 locallaw. 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. / am the owner, or l am authorized by the owner of this property to perform the work for which application is made, <br />a;7d / comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PFRnAIT 4+ _f <br />PIC <br />Owner/Authorized Agent Signature Date <br />