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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: G �, � PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaVsubdivision Lot No. (attach copy of long Iega�description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �,_� � � TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReer ��i� �X, <br /> � /� � . <br /> CIN STATE � ZIP ��.L-�,f <br /> OWNER PHONE: � ` � �� OWNER EMAIL: <br /> CONTRACTOR NAME; I� �� <br /> CONTRACTOR ADDRESS: sTReeT �� �j� , V�(.�Q,�� <br /> Cm' �,��(��' STATE � ZIP � ^� <br /> CONTRACTOR PHONE: �j ` � � � CONTRACTOR EMAIL: �' ,� i Q , 4.,�/� <br /> CONTRACTOR LICENSE#(REQUIRED):C %� `/}�� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ��, � <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: ,� CC�NTACT PHONE: �'�� +� <br /> � � ' �j ��— � 1 l ����JGX.IJ 1��� CONTACT EMAIL: �� ��r�-�'� R � ' �' �� . '�.� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ � � C�� <br /> Proposed Use of Building: Heat Source: �as ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached FR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ddition ❑Remodel ❑Repair ❑T.i. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WOR : <br /> c ' .. ,, . L�CJ� � Lv�'� "�'� I` vr <br /> ASSOCIATED HUILDING 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 /> Fixtures List of Fixtures Fi tures List of Fixtures #�� List of Fixtures #of List of Fixtures <br /> 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 Refri eration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Ran e 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 herein 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 be%re being authorized under any circumsfance.f 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 1 27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> �� � PERMIT# � <br /> r ` 'n / /��] <br /> � < 1 V( ( �Y l/ <br /> Owner/Authorized Agent Signature Dat (Revised 10/12/2015J <br />