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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING / SIGIV /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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> Pi20JECT SITE ADDRESS: �JI� � �� PROPERTY TAX#: vO+��clD��}3�O�f� <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (J��({�� LQ.Q'�'�'�- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReer �� �� �� <br /> CITY ���/tiJ�/'1�P� STATE W� ZIP (S�'V l <br /> OWNER PHONE: L� Z�S�t7 � QI OWNER EMAIL: <br /> CONTRACTOR NAME; `'��{�'n�� <br /> CONTRACTOR ADDRESS: srReeT �-(�� Q <br /> CIlY STATE W� ZIP ���0, <br /> CONTRACTOR PHONE: 5 Q CONTRACTOR EMAIL: e d(-}-�1 G{/Y�I�.eO�,j"�✓l • C�yy� <br /> CONTRACTOR LICENSE#(REQUIRED): �'�'Y1�'P,CI,�'Y�,I�I��Z,CI Yl CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): �LPOe(� <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: p� a'S l �i�Jb <br /> I ► l�Z��j �`�"�I CONTACT EMAIL: .el��-(-h C�I�eQ�jn •�0 ry� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ 2-�� <br /> Proposed Use of Building: Heat Source: �Gas ❑Electric ❑Other <br /> Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commerciai ❑Industrial <br /> Type of Project: ❑New �ddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> �,�.� c�.� c�= <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PWMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: New _Addn Alteration Repair <br /> #of List of Fixtures #�f List of Fixtures #�f Lisf of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixfures 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:l have reviewed this application and confirm the rnformation contained herein is true and correct. lNork done pursuanf to this permit must comply with <br /> current federal,state,and local law. The granting of a permrt only aufhorizes approved work and no deviations therefrom.Deviations must first be authorrzed in writing from the <br /> Building Official before 6eing authorized under any circumstance.I am the owner,or!am authorized by the owner of this property to perform the work for which application is made, <br /> and!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Eve�ett Official Use Only <br /> I��"��GY^�" ���� l�— PE MIT# � <br /> 'Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />