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PERMIT APPLICATION <br /> BUILDING I IIIECHANICAL / PLUMBING / SIGN / S�RINKLER / 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 /> � �+ <br /> PROJECT SITE ADDRESS: . I�i ��,U �� /'� L1c:� � �j'<, �'�(� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> � <br /> OWNER NAME: S ) G, , ,��r, �1 TENANT NAME (If Commercial): �• <br /> OWNER MAILING ADDRESS: srReET 'a (P�3�. �µ � ( l S�Cc� � � � <br /> CITY ��,��/li(' J��S STATE �� ZIP $v�� <br /> OWNER PHONE: LI a� '" 3��j -� � �C�C� OWNER EMAIL: <br /> CONTRACTOR NAME: 1'��PUu S cC-�2J�1 S <br /> CONTRACTOR ADDRESS: sTREET � G( '�°� S(fi <br /> CITY �' ' �j^ (j STATE w � ZIP <br /> CONTRACTOR PHONE: ��� -�C''/ � � � �" CONTRACTOR EMAIL: �b �' . � " � (, j�1 <br /> CONTRACTOR LICENSE#(REQUIRED):` � ' � � - � CITY OF EVERETT BUSINESS LICEN E#(REQUIRED).Cti���C(S <br /> PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR �OTHER(Please Specify) <br /> CONTACLNAME: CONTACT PHONE: L � � � - Z� <br /> / � ,-, � �S �� <br /> ���I f� ��� � � 6G°�Z�f����L�C� CONTACT EMAIL: ��f � SC�!(� C�=,��`(l �C.'(��v�� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: � � � C� ' Contract Price of Work: $ �� <br /> Proposed Use of Building: zi,� �(C- �a� Heat Source: ❑Gas ❑Electric ❑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: ` r <br /> "��1�14c._e �ttX �51��G', S�`�� �..,) �`��'� ��� ' f�it:�� � �" <br /> . � <br /> U I I! <br /> �%'�1 ��f � �uC���C� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <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 #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures 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: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No. of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained he�ein 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 fi�st 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> ^ City of Everett Official Use Only <br /> ` t ` � PERMIT# � <br /> � /� ��� � I� �V�j " �i�� � <br /> - � �-- <br /> Owner/Authorized Agent Sign e Dat (Revised 9/23/2016) <br />