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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 I(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION A. , ., ,... .. . <br /> PROJECT SITE ADDRESS:ZOIM el/II OPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION, ... . <br /> OWNER NAME:)1 ✓h WI 1/j/ J ' 9 TENANT NAME(If Commercialk J)y31y)'/fJ(�h/ f <br /> OWNER MAILING ADDRESS: STREET 2L'o 4-0GG.,�1/ <br /> CITY ��L.6�'i.G. J STATE ZIP ���1 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: ,t,vfZ l g7`'� S j <br /> CONTRACTOR ADDRESS: f STREET ?fat)"( ' STATE IA) <br /> r�L itia.e., A2( q <br /> CITY A ZIP 99 3 <br /> CONTRACTOR PHONE: 76 ?jS CONTRACTOR EMAIL:� e7�Z,ed)11 n 4‘,, � yJC!"GJc <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTACT: 0 OWNER kit CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT N,�1ME: t� CONTACT PHONE: 'j577 , e3 r ,5e.., ilv <br /> InPAP,1.-'( SV-iieS CONTACT EMAIL J _ y <br /> BUILDINGPERMIT APPLICATION , <br /> Existing Use of Building: Contract Price of Work:$ 6 "'•- <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electri ❑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: <br /> ivS-i./( 2 k3 s. k -- LI- <br /> ASSOCIATED BUILDING PERMIT#(if ap i able):'powt-el l%' �� I <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 /> NC—Air Handling Units Heat Pump f Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater i Bathtub Urinal <br /> Gas Piping 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 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 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 /> r City of Everett Official Use Only <br /> PERMIT# <br /> ( zftifi c-i s«r2-a0-L <br /> nrner/Authorized Agent Signature Date (Revised 10/12/2015) <br /> i /2. <br />