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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 p <br /> PROJECT SITE ADDRESS: G Z 1 S•V, 61 �d;% PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (S4fA1P1 f1(, & TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Gtc <br /> CITY r STATE ZIP <br /> OWNER PHONE: q?5-- 0'2— J 60 / OWNER EMAIL: <br /> CONTRACTOR NAME: /✓fy7OIA14t 5 JG/v Ce tPag1 4(eW <br /> CONTRACTOR ADDRESS: STREET lDr /(../ <br /> CITY SFv '{/r STATE ZIP q <br /> CONTRACTOR PHONE: &(/ yZ, r[10 CONTRACTOR EMAIL: S4eVe 7- <br /> CONTRACTOR <br /> CONTRACTOR LICENSE#(REQUIRED): /V�//OSCQ /M 3 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER XONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: ® CONTACT PHONE: 24 _ZJ SO d 15rq <br /> CONTACT EMAIL: s�ei/e <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 0 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑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. ign ❑Sprinkler ❑Demolition []Change of Use <br /> DESCRIPTION OF WORK: <br /> /f'3f4t ov", P/( / jlww CAGt �d�✓�/G4N�/N'�'�� y 1�X���Sf //� flGh�• <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 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:1 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 I al taw. TKe 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 b g auth 'i{ed under any circumstance l 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 S Cont ors aw 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Owner/Authori d Age'Kt It <br /> nature Date (Revised 5/20/2016) l/ <br />