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� <br />� <br />� <br />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 � wv,nni.everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: � D�� %3�C-�Z�-y L�% -�� PROPERTY TAX #: <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: `�— �(/{�2.Q,. TENANT NAME (If Commercial): %z(��jE�TQ JUTATL� <br />OWNER MAILING ADDRESS: sTaEET �U� 3 [�'+'� �jr SGt� <br />��n ��c�t,o.✓�h , Gt,�4- SrATE `rl�-- Z�P i8oa,6 <br />OWNER PHONE: �—�'t`/� OWNER EMAIL: . /'hQ�"C'8dZ . (�Y� <br />CONTRACTOR NAME: �c /I�(��,L�- LL.� <br />CONTRACTOR ADDRESS: sTReEr (p�/�U �f" �Y��L- �,� -� <br />��,-� c-�i�u� -r/ STATE n1� Z�P 9�?� <br />CONTRACTOR PHONE: �i'�• '�- • d 7`f�7 CONTRACTOR EMAIL: !'�� ��t.�.0/Q ��Ip�I�1Q,0` •GCT%� <br />CONTRACTOR LICENSE #(REQUIRED): ��ATN��, ��IG /�jl�L CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: �OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: /�G�t��c-i�-- CONTACT PHONE: �- ��,5 — T� J <br />CONTACT EMAIL: ' � : ��' r' ��Z. � /►t��l• ��►✓� <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 WORI� T'CA��- �Ol.fJ�(.�`���D !✓C� -P��''G�TiED / 2��'�lp �L{�'f.¢C'!a'�J��i U Gc%5i %%�i� <br />d� �/az<r� 1 s�v.2�4 � s.y-gD •,(EO w�tr�/.cr a�-� Fcz.e(G� ��tGsi��c,,e-7�, �S,2a. cr� �s,- �. <br />0�ut-/J �o x 2-i� �vls�+c7/� A�t-o.UC 5. �a-.�a� 5�/�7,� t(CE'atie��Qs Ta Cb�J� �c/� �/b�9e�� �.�.�c <br />��S�S • <br />ASSOCIATED BUILDING PERMIT #(if applicable):��� �� ��'�''sC <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Fixtures List of Fixtures Fixtu es 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 _Alteration _Repair <br /># of List of Fixtures # of 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 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 whidi application is made, <br />and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />Owner/Authorfzed A t <br />� � 1(�,-� �� � � <br />City of Everett Official Use Only <br />PE��T�� � � � � <br />P �� <br />(Revised 5/20/2016) <br />