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- PERMIT APPLICATIOI I <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� vv�wd.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:. r—, n, PROPERTY TAX#: <br /> „ � V <br /> LEGAL for new construction Short PlaUsubdivision Lot No. (attach copy of Iong legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (- %( -�, �� � TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReeT <br /> cirv sr�rE ziP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: (_ - I� '� '�{'�� y�;.�! -,. L„ <br /> CONTRACTOR ADDRESS: srReeT �- ; ��� ���� -1� <br /> CITY � �• �� ' ` STATE � �� " ZIP <br /> CONTRACTOR PHONE: � '� � .���� � CONTRACTOR EMAIL:��� - `,,�,'�- '��.� ..,���j,,� ' <br /> CONTRACTOR LICENSE#(REQUIRED): � - � �r' ����, CITY OF EVERETT BUSINESS LICENSE#�REQUIRED): C"3 C�?� <br /> PRIMARY CONTACT: ❑OWNER �.CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: ��N ���� CONTACT PHONE: � �i ��_�"� j�� �C� <br /> CONTACT EMAIL: .e��l��nL�t��"�1%'"., y .,_ ;'�-j;�'t/!'�t\I, - � i,''✓i. <br /> BUILDING PERMIT APPLICATION <br /> t�-'--5 " <br /> Existing Use of Building: Contract Price of Work:$ � K [:�-�l-- <br /> Proposed Use of Building: �''����! 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 I ❑Repair �T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK (y`L�'✓�l'�� � :�. 7-��r7- � i,,�F�•r�C�tT Tv i�L.t�Jni_,�� <br /> �w.���-c�F;;:�c��`x i �, :� �r��-!�s, �iAJ._>, l S+�a,-s�, � �►>Nk%�5�-�1 �hcy" _,±. � �. <br /> , <br /> � ����%r��� � '�����r��._,C:, j-t..t_h�tYA„r Ni i f`'�v�'j;.�st�� i 1...�-t,i Ct;'_y-{�.T"��--r�t{Lr�`- �l��f=°.,t ti)`�� <br /> ASSOCIATED BUILDING FERMIT#(if applicable): „� �-vG1- )�.�+-t�.���j <br /> ME�YHANIGAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New _ Addn _Alteration _Repair Type of Project: _New _Addn Alteration _Repair <br /> #of Lisi of Fixtures #of Lisi of Fixiures #�f List of Fixtures #°f Lisi of Fixtures <br /> Fixtunas 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 /> Number of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained her;^in is true and correct. Work done pursuant to this permit must comply with <br /> current federa(state,and local law The granting of a permit only authorizes approved work and norleviations therefrom.Deviations must first be authorized in writing from the <br /> Building OKicial before being authorized under any circumstance.1 am the owner.or 1 am authonzed by the owner of this properry to perform the work for which application is made. <br /> and I comply w7h the State Contractors Law 18.27 RCW and 296 200A WAC. <br /> � City of Everett Official Use Only <br /> ' � PERMIT# �) <br /> � i ������ ! i.� �� � ��:/ <br /> Owner/ uthorized Agent Signa ure Date (Kevised 10/12/2015) <br />