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PROJECT SITE AD <br />• PERMIT APPLICATION� <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EV=RETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteFs@everettwa.gov � www.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROPERTY TAX #: <br />EGAL for new construction: Short PlaUsubdivision Lot No. _(attach copy of long legal description) <br />CONTACT INFORMA'I� ION <br />lWNER NAME: '�j;�; �,,� �y- S���z,�,,,,,�,�,��.-� 5�ov � TENANT NE,ME (If Commercial): <br />IWNER MAILING ADDRESS: s-rReeT �� U � (J c� k e5 /� L•� , <br />CITY j^ �Cf'�—�� \ STATE W��� ZIP �1� �jl + <br />I:».[�7►1�I <br />OWNER EMAIL: <br />TRACTOR NAME; %�' ���.•�14 {��� i�-i<<.S.\nGI d-- Coo �: n�� �i-.�. <br />TRACTORADDRESS: srREEr 3y ($-' cJ�j ��c7,., S%, <br />CITY Lia�CL �'i'C.�/t ✓l STATE � � ZIP ( ;�._�S'�SJ� <br />TRACTORPHONE:�J�S'�j�(—��`TUd CONTRACTOREAIAIL:cL�t,ck�cJ,;�(-�,�;,�,�t��4;i�n,i���(7c+.c1�.i<�;,,�.c� <br />TRACTOR LICENSE #(REQUIRED): /� F}�p �. H.� `l I(: K E CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): �S�-S ��- <br />1ARY CONTACT: ❑ OWNER I� CONTRACTOR ❑ OTHER (Please Specify) <br />TACT NAME: CONTACT PHONE,: t fiLS -3jy -G,�`( v�j <br />,�uc_it �Gr���v.�� CONTACTEMAIL.-�.,,.�kfo;:t`F�:�itibilLrc::i�:�w�n.:i��_•I:.,..�..� .if ��.� <br />BUILDING PERMIT APPL ICATION <br />� Contract Price of Work: $ ���'c'�' <br />Existing Use of Building: r s. cl e �.�` <br />Proposed Use of Building: Heat Source: BGas ❑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: <br />��;t�.ct �t 2 I-��_�� ��,�.:.1�1.��.s h��,�,���.�,� srsi��r,-, <br />, <br />ASSOCIATED BUILDING PERMIT # (if applicable <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn �Alteration _Repair <br />Fi�cfures List of Fixtures Fixtures List of Fixfures <br />A/C - Air Handling Units Heat Pump <br />Forced Air Systems Unit Heater <br />Gas Piping Boiler <br />Water Heater Refrigeration <br />Gas Fireplace Wood Stove <br />Gas Range Ducting <br />Clothes Dryer Hookups Other: <br />Range Hood <br />Exhaust Fan <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />I�LUMBING PERMIT APPLICATION <br />Type of I�roject: _New _Addn _Alteration _Repair <br /># of Li:1 of Fixtures #°f List of Fixtures <br />Fixfures Fixfures <br />Toilet Backflow Preventer (Inside Bldg) <br />Bathtub Urinal <br />Lavatory (Wash Basin) Drinking Fountain <br />Shower Floor Drain <br />Kitchen Sink & Disposal Grease Trap <br />Dishwasher Roof Drains <br />Clothes Washer Medical Gas <br />Water Heater Other: <br />Sink (Service/Bar/Mop/etc.) Other: <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 local law. The granting of a permit only authorizes approved work and no deviations therefrom. Deviations must first be authorized in writing f�om 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PERMIT # n �1 <br />�, r'-' � �-,..��. l 2� l 6- 2 c> I j � t������ t1 �� <br />Owner/Authorized Agent Signat Date (Revised 10/12/2015) <br />