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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 I� everettwa.gov/permits <br />CONTACT INFORMATION <br />OWNER NAME: �5:� r(3! { �1,�,� � 2\ TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTREer �?� j 1 Sr—" j-� . S�. <br />CITY � V Q��. �" STATE i�'� r�� ZIP �� �i V' � <br />OWNER PHONE: � L S Z 3 1-���`t OWNER EMAIL: �� 55� �L � ��' =- 4`�-- • L� �'1 <br />- �\ � <br />CONTRACTOR NAME: �,�' lv� ; i�:'C 4.Z` +�- � ��' <br />CONTRACTOR ADDRESS: srReer -- t; � fjL � �. � <br />� L?." " \LLi� - _ � <br />CITY -�' •. d.- ';�•- .�.. STATE 1.... �� ZIP .��' G C.. <br />CONTRACTOR PHONE: Z � �� G� ( 5 " CONTRACTOR EMAIL: -('�`'rj-� - } �1��' � ;,;� �; ,[, (',� . ' � . <br />CONTRACTOR LICENSE #(REQUIRED): '�:r'S'� � G� .9 fb'1 CITY OF EVERETT BUSINESS LICENSE #(REQUIRE,Aj'"9 'Z3� % `' <br />PRIMARY CONTACT: 'S�OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) ----�"� <br />CONTACT NAME: ` CONTACT PHONE: � ��_ ��j �- 7 30, � <br />� � �� �. ��� `� � , 1 <br />CONTACT EMAIL: j t_S=� � C, �� L" c�-I�L-�� . c,�.� <br />BUILDING PERMIT APPLICATION <br />Fxisting Us� of Bu�ldin�: `� j� (= 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: eJ ` <br />�� ��I�Li-CJL. V+Ja"..�� �LT�-4� C'he�.vtk-, �.J� �--��:-+�.� �- SS �.�.J<..L�Ir� V�2.G�.4c'.,4' <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 Fixiures #�f Lisf of Fixtures #°f Lisf of Fixtures #°f Lisf of Fixtures <br />Fixtures Fixtures Fiztures Fixtures <br />A/C - Air Handiing Units Heat Pump 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 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 before being authorized under any circumstance. 1 am the owner, or I am authorized by the owner of this property to perform the work for which application is made, <br />and I comply with the Staje-EoAt[�ctors Law 18.27 RCW and 296.200A WAC. <br />nature <br />City of Everett Official Use Only <br />P,ERM T # <br />� . az-�� �''�i� � � �� � <br />)ate (Revised 10/12/2015) <br />