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• PERMIT APPLICATIOI� <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 />PROJECT SITE INFORMATION <br />� ..l���✓r��� �v'e�{='�' J'�f"-'_.j: W,�1-�l I� `✓'✓-f'�',=`�IJl3✓.J'�:J'�. U�Z�GC�.���1'?"J�� . �j;�t-�" <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) �ty �_ D. � <br />CONTACT INFORMATION - <br />OWNER NAME: J�/} V` �--� ���?;{�Z 5 � i_('I-1 /�I�iJ�� TENANT NAME (If Commercial): �/��'�'�j-_�.cv j l�"'; '�"j �� S <br />OWNER MAILING ADDRESS: sTREEr � ��' J /� r�S��,� )Z I(/(r'- �. <br />CITY �=./�-��= STATE J4 ZIP q J✓ I� L► <br />OWNER PHONE: �iJ(� - 3� ' - � ,;✓ �3 J OWNER EMAIL: --- <br />CONTRACTOR NAME: �2;� - �, j ,� ="-�= �_ � � �� t_ <br />CONTRACTOR ADDRESS: sTReer � V. ��� 3 j 3 7�„� <br />CITY "�'�= � �- ��- STATE w� ZIP � � � � <br />CONTRACTOR PHONE: �,J (g -"3 (,� — U�% I CONTRACTOR EMAIL: )i_-(1-iZ����ci—S j.. `'= j=�� j�- 1 � C C.:�V`1 <br />CONTRACTOR LICENSE #(REQUIRED): IZ ✓S \ j�� ��`� C CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): �I�j_SG� � <br />PRIMARY CONTACT: ❑ OWNER ONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: � {„! (v — "� �� � �- � ��;,3 ��� <br />r�'��c C ZF l..1..1=� CONTACT EMAIL: yiT�2 �'�,�.-� -� i ��- -{ _�:-.-�r+'o <br />BUILDING PERMIT APPLICATION �� ; Ci"�% <br />Existing Use of Building: .,�.�.--. } �`- - ;A - � � �` y� �"� <br />- � �,_ ,,_ � y �,�� � /4-� Contract Price of Work: $ � "'� �— - <br />Proposed Use of Building: �� �� Heat Source: ❑Gas �lectric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: �ommercial ❑Industrial <br />Type of Project: ❑New ❑Addition �Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />N�-�,,,/ F'���— �+�,=A-i �,_cv��_,z�� ,"�f�NUM�n��i�=Z S�"'�1�--5,/���M� <br />�L .� :i ir'1 :J ��' I_�C I i A�" `%1�1 j l �J C: j`vl�;J l'L Y� \ t= � ��!i l�1` � 1 �'%I J� f � ��i f-� S. I t= <br />� - 1Z -I-I�I�11=i� \ � / �%� �� J_ �"'_- <br />f��f'�hl C,,� cJ�JI_ ' 1/�A�T_�2 ��t'��y C'� ��:7��l�.��-`j �a? �✓ �=X�_5"I 1Nc� if`! ('��rLe_iZ ,? o..:��",+i <br />ASSOCIATED BUILDING PERMIT #(if applicable): ?��,7�A'(r Oly�' -��St r31�3 <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 Fixtures # of List of Fixtures #°f List of Fixtures #°f List of Fixtures <br />Fixtures Fixtures Fixfures Fixtures <br />A/C -Air Handling 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: :�,.�i Clothes Washer Medical Gas <br />Range Hood r7,'-_NJr+�tn�f-i = Water Heater Other: �?��� �,/s�r-_�. ?in,N .y <br />Exhaust Fan Sink (Service/Bar/Mop/etc.) Other: �J.; ,�+, h-� p� ��_ <br />J�� f'�)i'� )��:_!:_'JL. <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />ACKNOWLEDGEMENT: 1 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 granfin,g of a permit only authorizes approved work and no deviations the�efrom. Deviations must (irst 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 perform the work for which application is made, <br />and 1 co !y with the State Contra or Law 18.27 RCW and 296.200A WAC. <br />� City of Everett Official Use Only <br />- � PERMIT # <br />,, , % �� �� �� ! � 1� 1�"7/� - �Z- <br />ner/Authorized Agent Signatu � ate (Revised 10/12/2015J � <br />J <br />7 . <br />