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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 />PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: ���� i)L . t �� PROPERTY TAX #: <br />!`t <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />iR NAME: �", � i,, �'� � L� TENANT NAME (If Commercial): <br />:R MAILING ADDRESS: sTREer j'L U� I �'I J�?" irtll e/ <br />CITY ��✓P I ��T STATE �%�- <br />:R PHONE: �� �j � � � - �� (jl �- � OWNER EMAIL: � � � k, �� G r'v btl . U <br />RACTOR NAME; � i I I�V VI �i �G'V i' Y� �i" ,j ('''�i1 I �, T�l ( L i�1 ✓1 I'���� �{� i" �� L�C� -�' j� ! t I^ �� '/� <br />RACTOR ADDRESS: srReeT � �(i I I 1� t� �'1( �. �! i� <br />cirv <br />ZIP �� <br />STATE ��I� ZIP (?'1/� �� � <br />� <br />CONTRACTOR PHONE: �UV' - 2�� I ` �14 CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): r��!. ' � � C� �' � ` k � � <br />� ��„ , ; �� �� �, CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): � �L{ _ ', � <br />PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: � �^ CONTACT PHONE: ,� �^) � c� �� � lj � <br />(� ,C� C-+r'1 � t i.-``�' <br />��/G�2�� `- C�''�`s"'Y ( j �� .�. �. 4Zt'L; �L.'Cs. CONTACT EMAIL: 1-� j;J 7"C' Zcx; r, �-.�� Lt.Cr �� (.; i k'��C3 t� (�. C C�'-"� <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 �4ulti-Family-# of Units: t ❑Commercial ❑industrial <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Chan e of Use <br />DESCRIPTION OF WORK: <br />�� C- I,� C �"-1 V1 �� �� h� T� U� �7 r'� �- 1 v'1 S�t, I I vl S� �) �vr t� 1�1 � t i�Li ��;� L�� �� 1� �"1 �" �,r� �, G� Y' {� t' ►'� <br />�`��l t'i� �1�� t"'i�t � rt 1-lt l i TP G G� f,o�. S�;r C ��15 tnllni�-�p�.� v��� � I � i: v°i.S� c� fi'�, ���'.c°,k C <br />ASSOCIATED BUILDING PERMIT # (if applicable): (1 ( ►�l � i' � � ; I"C- `'+�t: <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br />#°f List of Fixtures # of Lisi of Fixtures # of Lisf of Fixtures #°f List of Fixtures <br />Fixtures Fixtures Fixtures Fixtures <br />A/C — Air Handling Units Heat Pump Toilet Backflow Preventer (Inside Bldq) <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 />Bathtub <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 />Other: <br />ACKNOWLEDGEMENT: I have reviewed this applrcation 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 pertorm the work for which application is made, <br />and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PERMI # <br />' �� ;,,, C� _ � � _� - I '- � `�� '�J �i' ��- <br />Clwn�uthorized Agent Signature Date (Revised 10/12/2015) �� <br />