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PERf�iIT APPLIC,4l"IORI <br /> BUILDIP Ii11ECFiAIVICAL/ PLUfiliBliVG /�IGiV RINKLER/ DEMOLITIOiV <br /> CITY OF EVERETT PERMIT SL=RVICL� <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 INFORMI4TIOPl <br /> �PROJECT SITE ADDRESS: I � �j I �f} ��..t� � �'�, �il��- PROPERTY TAX#: �7 �:�" � � ���.('��G.'�'�3 <br /> LEGAL for new construction: Short Piat/subdivision Lot No. (attach copy of long legal description) <br /> COWTACT INFORM�I'TIOPI <br /> � OWNER NAME: C.� ��-f=�� j'�US f T--f G ��-P'� - TENANT NAME(If Commercial): �F�FI- ��.N9�.^ ,-�US'3 n-�(,- � <br /> � OWNER MAILING ADDRESS: srReer � � �Q �'� <br /> `�� CIT'( ���_�, � " STATE 1N � ZIP � U �� 1 <br /> �OWNER PHONE: r`��S Z.��7 '- � C�1 �, OWNER EMAIL: �.�-5 �✓� �� 6�1�- � C>r- <br /> _ . . . . . _ <br /> _ ...... . .... . ... ___. .. . <br /> _ .,.. „ . _. .. _ .. � <br /> CONTRACTOR NAME: �"���L,r- �{ C�-,�� p,r r�- �e�C- 'L � L,L' <br /> CONTRACTOR A�DRESS: sTReeT � � O S �� � � ST � I t 1 S �C� `yj Gj� ( z.(c� I <br /> CIN S(� - � STATE W� ZIP ( �7 �b I <br /> CONTRACTOR PHONE �� bU� -' �C)��O CONTRACTOR EMAIL: 3'ylU���C A�' ` C>"- �- = CU�^� <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> �1 t=. 6�'� <br /> �� � �,�{-y�( � y �� ���� CONTACT EMAIL: � �- 0�-� <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 ❑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: p � <br /> �'�v'e •-Q�� �c,N�a a�'� '��--.�C����� ��<�r.e 3`'� �' �a �i�.f�"�'� S L6i � , <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alferation _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fi�cfures #�f List of Fixfures #°f List of Fi�cfures #°f List of Fixtures <br /> Fixtures Fixtures Fixfures Fixfures <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.'1 have reviewed this applicafion and confinn fhe informafron confained herein is true and cor�ect. Work done pursuant to fhrs permit must comply wifh <br /> current federal,sfate,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 circumsfance.I am the owner,or l am authorized by the owner of this property to perform tl�e work for which application is made, " <br /> and I comply with the State Contractors Law i8.27 RCW and 296.?OOA WAC. <br /> Ciry of Evereff Official Use Only <br /> PERMIT# <br /> /' � /z � / � �Lc�(�, , q <br /> OwnerlAuthorized Agent Signature Date (Revised 5/20/2016) , <br /> `�-v . <br />