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�i � <br />Ip►r <br />� <br />� PERMIT 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 I FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />1, '"? ' <br />PROJECT SITE ADDRESS: �'7�;� r ' y, PROPERTY TAX #: <br />LEGAL for new construction: Short Platlsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME �. �= i 5' - j' �ti( TENANT NAME (If Commercial): <br />�� � <br />OWNER MAILWG ADDRESS: srReer /� ���� �' i � <br />� <br />ciTv �V'�i,�� srnTe y,�-� ziP �� �y .7��� <br />�� � � ,�, <br />OWNER PHONE: ,�C�.� — �r _�-� ��' �� / OWNER EMAIL: <br />CONTRACTOR NAME: �'� � � , � t2 7 - %, ' <br />CONTRACTOR ADDRESS: srReeT /� � �%,S� ` � ���� � Ir` V� <br />J'�' � �•,,/� ;-� !� ,� . <br />CITY �� frL,�'V �„q .f STATE `/`. ��.�... ZIP ( �� L' � L •, <br />i� � "� <br />CONTRACTOR PHONE: � L' •-- �� � — + � � CONTRACTOR EMAIL: ,�ji G; �%%T/, , ���s �'s3�� ,,� � • ,.,���`� <br />CONTRACTOR LICENSE #(REQUIRED): �/�`��%�/7���� �1 ��'( � CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): r g <br />PRIMARY CONTACT: ❑ OWNER f� CONTRACTOR ❑ OTHER (Please Specify) <br />� -}P jy_�-/i�� <br />CONTACT NAME: � / CONTACT PHONE: �� ,Y �� ,� � �y <br />� %/;L�l � <br />CONTACT EMAIL: /�: G� �;i /J/L�'�'/Jit,�i '�' /z�<`yi <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: Contract Price of Work: $ <br />9 ',"�7 <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. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: '�^ � � � � ',� � ��� /� /'�_��� � �.. <br />�t'�" D 7Z �,��� 7 f1� � r f� y'r a' � 7- r�L� <br />�''���� [� ��� �'� �'G �/ �� Gc i ��l' � �fi✓J/ � 4 y��i��' � L/��yL t' � C�.�.Z ,i / � %� <br />(n.-��, G*� iJ /� - r�- �.� � <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Fi�cfures Lisi of Fixtures Finfures Lisf of Fixtures <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 />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Aiteration _Repair <br /># of List of Fixtures #°f List of Fixtures <br />Fixtures Fixtures <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: I have reviewed this applrcation 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 aufhorized in writing from the <br />Building Official before being authorized under any cira�mstance. I am the owner, or I am authorized by the owner of thrs property to perform the work for which application is made, <br />and l comply with the Stafe Contractors Law 18.27 RCW and 296.200A WAC. <br />- Ct f E tt Off ' I U O I <br />Own <br />,�_� - <br />- � �_ -�� - <br />--- � y __ <br />Signature <br />i y o vere ic�a se n y <br />PERMIT <br />�� i� ���� <br />(Revised 5/20/2016) <br />