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PERMIT APPLICATIt:. <br /> BUILDIN�i � MECHANICAL / PLUMBING / SIGN 1 �PRINKLER / 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 /> PROJECT SITE ADDRESS: Z 2� U� a��° PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdlvisior Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Q �- r�►/`�N�(�(,. � TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReer '1 J ' pG Fj <br /> CITY V �' STATE ZIP Zj0'�'�1 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME; D�t/ <br /> CONTRACTOR ADDRESS: srHE�r <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(RE RED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: ✓��S rj��� ,�j��� CONTACT PHONE; ¢2„("'.Z,f�-�'JG6 <br /> CONTACT EMAIL: � ����1+���-�,�+r n.Ae�- <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: �N f�-�LL IUCh/J <br /> �Q�4 A�.�,k�M� � Tu ,P,��(�..{,F <br /> l�.�Ct,1�N� s (�oN <br /> ASSOCIATED BUILDING PERMIT#(if applicabie): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #�f List of Fixtures #of List of Fixfures <br /> Fixtures 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(ServicelBar/Mop/etc.) Other: <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT:1 have reviewed this application and confirm fhe 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 before being authorized under any circumstance.1 am fhe owner. or!am authorized by the owner of this property to perform the work for which application is made, <br /> and I cornply with,the State Contractors Law 18.27 RCW and 296.ZOOA WAG � �b �v_ U�-1 <br /> � City of Everett Official Use Only <br /> l�'1��/,� PE V W# '' Q� � � <br /> OwnerlAuthoriz ent Signature Date (Revised 9/23/2016) <br />