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• PERMIT APPLICAI'10� <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: ?j(�� j - � ; � ��� L .� PROPERTY TAX #: G � � �% I � �C� � J � <br />LEGAL for new construction: S � 1 Let--Ple-�. (3��CF1C(1�1�[1�f Innon IP�I fIPC_!`�;,P��� <br />OWNER NAME: �� L N TI�. G 1' �AZ/� <br />OWNER MAILING ADDRESS: sTREEr �Z�{Ii <br />CITY ��j-vi <br />OWNER PHONE: J(�3 -' ZZZ — S �( <br />CONTRACTOR NAME; S L� 5�TzjJ <br />CONTACT INFORMATION ' <br />�(n .� LL('� TENANT NAME (If Commercial): <br />�- STATE (�� ZIP <br />OWNER EMAIL: CS�RN � 1.��(`a�t:��Y -C <br />� i.c <br />CONTRACTOR ADDRESS: srREET j Z`j Z z L�-�,� }� L�l.C� <br />CITY ��� m,(� � STATE � � ZIP <br />CONTRACTOR PHONE: ,�S$�p -(� . I CONTRACTOR EMAIL: �, 1�, �� l_�, L 1�^ <br />CONTRACTOR LICENSE #(REQUIRED): � L� ' L, ,„ � CITY OF EVERETT BUSINESS LICENSE #(REQUIf <br />PRIMARY CONTACT: ❑ OWNER �'CONTRACTOR ❑ OTHER (Please Specify) �Ol I �� e- <br />CONTACT NAME: CONTACT PHONE: - ' � - �'1 <br />� ,�G -l;}��� � �� CONTACT EMAIL: -��� ' �?�(_L (�T� ' 5�--� <br />S <br />BUILDING PERMIT APPLICATION c� S j�J� S 1(� �1 • � <br />Existing Use of Building: Contract Price of Work: $ �,p �-C-3- <br />Proposed Use of Building: Y� Heat Source: ❑Gas lectric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: �5�'6mmercial ❑Industrial <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair �7.1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />�Gi�'1-C��c�l� Cu1- �ut�l' i--c!�Q 1�L-�4.r-ti, 4�c.t1�S� �c���1„ ��ck�r1� iZCt�; ��tc� l.�;c�1�S �c� <br />� �.��.�f� a -�'-� � �s s o���� �w�ss�'-�- , <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Fi�cfures List of Fixtures Fi�cfures 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 />Ciothes Dryer Hookups Other: <br />Range Hood <br />Exhaust Fan <br />SPRIN6(LER / 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 />Fixfures Fixtures <br />Toilet Backflow Preventer (Inside 61dg) <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: l have reviewed this applicafion and confirm the informatron contained herein is true and correct. Work done pursuant io 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 l am authorized by tlie owner of this property to perform the work for which application is made, <br />and I comply with fhe State Contracfors Law 18.27 RCW and 296.200A Wl�C. <br />Clty of Everett Official Use Only <br />�/���� J n PERMIT# <br />�,l l,G'� 1.�i/t�� �' � �P - � %�' � � �Od � ' � ��' <br />Owner/Authorized Agent Signature Date (Revised 5/20/2016) i <br />1 `� <br />