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iPERMIT APPLICATIOf� <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 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT SITE.ADDRESS: PROPERTY TAX #: � - --_,� - - . <br />� . �� .- � r� _/'� ��,�'> > C�l ���+'%� �- <, <br />LEGAL for new construction: Short PlaUsubdivision L-� t-:�%-� C L_ Lot No. `� (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: ��--�=-�(% _Sj �/,i;���S TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: srREE� � Q. j�6 � /�p y "iJl co''�7�' !T -(.l.��( �;�'� <br />CITY /� (.J(4'O� Ct �(( STATE (/�V'T' ZIP �J �"' <br />OWNER PHONE: ZC"�F� -� yO" 7Co Z L/ OWNER EMAIL: <br />CONTRACTOR NAME: C�l-VNC`'+J2 <br />CONTRACTORADDRESS: sTREET %��%�Gj� /(o� �� ��i`�j��4 /% <br />CI7Y ���Z�z' < < STATE �j,f� ZIP ��jLC� <br />CONTRACTOR PHONE: CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR � OTHER (Please Specify) ,l�IF-�'l`r /'�f%/�i��' � /°�i!,�'r/J� <br />CONTACT NAME: �j��L%i� /i���f'�JY CONTACT PHONE: .; ��� - �-7�. �. 7 < <br />j�C�r� -"� �Z �s � f CONTACT EMAIL: �,-j/3U/Li��'►�SCJY/�i-icY� <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: ;�`� l�-I'� �l� ��:� %T""ri Contract Price of Work: $`/�-��J <br />Proposed Use of Building: Sf-/'�, Heat Source: ❑Gas DElectric ❑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: �`%;1�4C� ,�6�7�"/�� `riLL�'cl �; �<� Y`Git�TctJ � ��j'�-'�� /`��T( c'��J �� � �-�-s�y�. <br />�` ��iSr� �✓ rP� f:17— ,�= l i< lz_c.G�t � f ,- �� L�ti t-lsi M G- LLLC�- c-LS �- j<< �,� <- c. i r" �" G.'�-C� - <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 #�f List of Fixtures #°f List of Fixtures <br />Fixiures Fi�ctures Fixfures Fixtures <br />A/C —Air Handling Units Heat Pump ,L 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 y 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 6efore being authorized under any circumstance. 1 am the owner, or I am authorized by the owner of this property to pertorm the work for which applicafion is made, <br />and / comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />i� -��� rs- <br />uthorized Agent Signature Date <br />City of Everett Official Use Only <br />PERMIT # <br />��/f51� -�� <br />(Revised 10/12/2015) <br />�Cz <br />