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PEFtIVIII"APPLICATIO�� <br /> BUILDIN IIECHAiVICAL I PLUMBING / SIGN �. �INKLER / 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 /> __. _ _ _ <br /> ;; `, PRO.J_ECT SITE INFORMATfON : ` <br /> PROJECT SITE ADDRESS: /' � - � PROPERTY TAX#: .,� f ° U �,�-C�C• <br /> v i,��� f/ll� �'� uJ / �- L�U - <br /> LEGAL for new construction: Short Plat/subdivision('v�.3.0— �Ca/L�" �%CG�', Lot No. � (attach copy of long legal description) <br /> ' ' CONTA�T 1NFORMATION ' <br /> : : . -� , <br /> OWNER NAME: �'�i�' � ,i c' UG�J � " i(,'( , TENANT NAME(If Commercial): G'�='CL "I~ <br /> OWNER MAILING ADDRESS: sTrzeeT �� l% . ,�^S C_� . ll <br /> CITY C1 � ��!L-L �L STATE ��(_/ Z�P `1 J CG' <br /> OWNER PHONE: L-(�..� ` G �C, ` L-: �� OWNER EMAIL: /`/ /� U ��� �C� G`� L /1 � �4! / <br /> _ _ _ _._ _. <br /> CONTRACTOR NAME: Ll jT �� ��. V �,T- _ � L� ��/r/�S/ . /t�C- <br /> CONTRACTOR ADDRESS: srREET � � . ��_; � ,,� 1� <br /> CITY ��-� � � S G��l��" STATE � ZIP Y CL/��U <br /> CONTRACTOR PHONE: L(� / � , 6 "(d � � CONTRACTOR EMAIL: /� �"� ' �'c �= r_ � 1•�li� <br /> CONTRACTOR UCENSE#(REQUIRED): � '�T�'�C � � CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): '� � <br /> PRIMARY CONTACT: ❑OWNER ff�,CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: � �— _;'�7�- �� �--� <br /> �'L- � V CONTACT EMAIL: ���� K �C? :� � •C�s�-� <br /> ' <. ' BUILDING PERMIT APPLICATION . <br /> _. _ . <br /> Existing Use of Building: C`����f � � Contract Price of Work:$ �-�'i' <br /> Proposed Use of Building: 5 f- ) Heat Source: �Gas ❑Electric ❑Other <br /> Building Type: f�F-R-DeEached R-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: New �Addition C7Remodel ❑Repair �T.I. ❑Sign ❑Sprinkier ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: L J� �'TrZL,C�T-- �,,���% S ���- <br /> � y�`�� '� � " " - 'I'�C.� <br /> �`� , `�� S ��- � �"� C �=l�'�z t�<<� �Gf- <br /> �,;z�? �l{�� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> ' MEGHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLfCAT10N <br /> Type of Project: �New _ Addn Alteration _Repair Type of Project: �New _Addn _Aiteration _Repair <br /> #°f List of Fixtures #�f List of Fixtures #of List of Fixtures #°f List of Fixfures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units fieat 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 e Other: <br /> '" Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> ..` ,�,'i_' l,�F� J <br /> SPRINKLER/ SUPPRESSION SYSTEM J-i��� <br /> Number of Heads <br /> ACKNOWLEDGEMENT.�1 have reviewed this applir,ation and confirm the information contained herein is true and correct Work done pursuant to this permrt must comply with <br /> current federal,state,and local law. The granting of a permit only authorizes approved work and no deviafions fherefrom.Deviafions must firsf be authorized in writing irom the <br /> Building Official before being authorized under any crrcumstance.1 am the owner, or 1 am aufhorized by the owner of this property to pe�form the work for which application is made, <br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Crty of Everett Officia!Use Only <br /> � � � PERMIT#,. <br /> �--1�: �= e � �� � �� � �' r <br /> Own /Au �orized Agent Signature Date (Revised 10/12/2015) � <br /> � �, <br />