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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 � www.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: PROPERTY TAX #: <br />� -� � r Q v�. ���r:��� w�-c7g ��r �e5 � �;1L � <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: �n,��/L e�iCS� TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: srReeT ��Z ( ,� �j�.i�{� <br />CITY �V�,�( STATE �Ml� ZIP ( �7 �' � <br />OWNER PHONE: �7�'j �j2 ^ ZZ� OWNER EMAIL: Gf}fj�l'1'll (�(Lleiz-�' �(dG, �C.YI <br />CONTRACTOR NAME: n(�J �j�.� '�L.L d-- J,j/ ,=,i <br />CONTRACTOR ADDRESS: sTREET � 3 I L� 1�1 ' <br />CITY �' v n � STATE LV,� ZIP � L{1 D <br />CONTRACTOR PHONE: (cZ? �E �O � Z�'L'd� CONTRACTOR EMAIL: INj c�, �,�J�,r}.((()S �, NF� <br />CONTRACTOR LICENSE #(REQUIRED): u L'� t{�(.��.��'�S L'f TVJ CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): b5 '{ 2Z <br />PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: (cG �{(p�.- Z�{vS <br />�'��r%iT— ��'� CONTACT EMAIL: w�,e}.`t(-� 11ld,J Ef�/Zp5<q-��s� /�lEa <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: (��� (� �/�A'��(. Contract Price of Work: $ "� ��% ��v <br />Proposed Use of Building: �� ^� s� (.�j�•� 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: 8��� w�` �� �`� �E��% �P�� K� �� <br />Fy D 6..r:k:, t cc..�Tti�' �4 T' S� �`��' � <br />/�izo�k I�:��� g!� 2�f Sa�.t�- F�'r, <br />D � <br />ASSOCIATED BUILDING PERMIT #(if applicabl� }�� s� <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 Fixiures # of List of Fixtures # of List of Fixtures <br />Fixtures Fixtures Fixtures Fixiures <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: 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 herern 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. 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 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />G� � ������ /_, � "_ /�O PERMIT # �� � — <br />� G �i <br />Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />'IZ <br />