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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 FAX 425-257-8857 (E)everetteps@)everettwa.gov www.evereltwa.gov/permits <br /> G ,C PROJECT SITE INFORMATION <br /> PROJECT ITE ADLyREp,�: J• PROPERTY TAX#: <br /> LEGAL for new construction:" Short Plat/subdlvlslon_ -_—Lot No._ py onq legal description) <br /> (alta"ch'co of' <br /> CONTACT INFORMATION <br /> OWNER NAME: [pCit.) ;ji r/) TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET jj;i _ L`'i 711�,r'r j,. ✓ ? <br /> civ i� <br /> r jlr;rl �.� <br /> � STATE(/i/ "1r?Ir?-i zip � �,• <br /> OWNERPHONE: r i Lrr'.n} OWNER EMAIL: i.4/7� <br /> t L:_ <br /> CONTRACTOR NAME: y r"'( )JY-1 '"I iA ",-I(` d ,'I; 1 <br /> CONTRACTOR ADDRESS: srREET 7 <br /> CnY STATE' 1 <br /> Z{ Zip 9 <br /> CONTRACTOR PHONE: 424'-- R' 7 ?(o,2 1CONTRACTOR EMAIL: f / <br /> CONTRACTOR LICENSE#(REQUIRED): �l`) �/vl'f,I t Ol CITY OF EVERETT BUSINESS LICENSE#(REQUIRED); r-5 L 4; <br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify)_ <br /> CONTACT NAME; CONTACT PHONE: <br /> CONTACT EMAIL: - <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: C tract Price of Work; <br /> Proposed Use of Building: n }`c Heat$ourcei- ❑Gas--❑Electric ❑fatter __ <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units; MCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ®Repair ❑T.I. ❑Sin E)Sprinkler ❑Demolition Cl Change of Use <br /> DESCRIPTION OF WORK: <br /> ) (NA <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 #of #of — <br /> Fixturrs List of Fixtures List ofFJxturas <br /> Fixtures Fixtures List of Fixtures <br /> Fixtures <br /> AIC-Air Handling Units Heal Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas r He Bailer Lavatory(Wash Basin) Drinkin Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove I 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 Qiher:(� � q t n•,�.;y j,,,.- <br /> Exhaust Fan Sink(Service/Bar/Mop/etc. Other: <br /> SPRI,NKLER1: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 Willi <br /> current federal,slate,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing born the <br /> Building Official before being authorized under any circumstance./am the owner,or I am authorized by the owner of this property to perform the work for which application is mane. <br /> and I comply with the Stat8 Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT>k <br /> Owner/Authorized Agent Signature Date (Revised 1 0/1212 0 1 5) <br />