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� PERMIT APPLICATIO� <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 />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: v�� � ��C��-(-�(`'�i'C �j� PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: ,L��.�� ii:(I� �•v��'-�i�� TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTRee-r � �� r� <br />ho��� Y �'��-��-E k�.Oc�( i�� <br />CITY �L��`��� STATE `�''�� ZIP 0,�7�Ci �. <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTOR NAME: G�E.S � ���� f-�"�(��1 ST J�Ii�l��j� �J�I�I <br />CONTRACTOR ADDRESS: sTREEr %-`� v� S`�� �"i�-� r� '_`+� <br />CITY ��t�.��"'� STATE °d•�/� ZIP a� lJ ��V <br />� <br />CONTRACTOR PHONE: i��Ci6 " �'"f � � -• ZS��,.,��� CONTRACTOR EMAIL: (��•:( • ��'' ��t � /i. 1'�r:1C �S �^� C %�+c`.i�• �C��"� <br />CONTRACTOR LICENSE #(REQUIRED): ��AK-�.���'���{�`�C� CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER ONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: '?.�Jb -- � `' � J -- � � '� �' <br />� 1� <br />�In^1,ZS.���`�( �cv.(�\�ST ` CONTACT EMAIL: :_',.1:.� ��? -��(• �1-E�V.I��S�'✓� _ �v��.��. r,T�s:.�. <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: Contract Price of Work: $ .� <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 />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Fixtu es List of Fixtures Fixfures List 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 _Alteretion _Repair <br /># of List of Fintures #°f List of Fixtures <br />Fixfures 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. L ��,-t�=•r ��+;-r=�1 <br />Sink (Service/Bar/Mop/etc.) j Other: ,,,:.���V� �, <�' � � <br />��� � <br />ACKNOWLEDGEMENT: 1 have reviewed ihis application and confirm the information confained lierein rs true and correct. Work done pursuant to this permit musf comply with <br />current federal, state, and local law. The granting of a permit only autliorizes approved wo�k and no deviations therefrom. Deviations must first be authorized in writing from the <br />Building Official before being authorized under any circumstance. I am the owner, or I am authorized by the owner of this property to pertorm the work for which applicatron rs made, <br />and I comply with the State Conira�s Law 18.27 RCW and 296.200A WAC. <br />'�jG %�U(�ZU(� <br />Owne�GFCGthorized Agent Signature Date <br />City of Everett Official Use Only <br />PERMIT #, � I �� � D� � <br />(v <br />(Revised 5/20/2016) <br />