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� <br /> � PERMIT APPL9CAT'ION <br /> BUILDING / MECHANICAL / PLUMBING /S9GN /SPRIfVKLER/DEMOLITIOIV <br /> CITY OF EVERETT PERMIT SERVICES <br /> � !� 3200 CEDAR STREET,EVERETT,WA 98201 <br /> � P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everetiwa.gov� www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE IIdFA12E1AA'r1AM <br /> � 1 � A , <br /> PROJECT SITE ADDRESS: " `? r �' ���1 ! v �,; �- 'l �' `'Y. "� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision r)�`� Lot No. �� (attach copy of long legal description) <br /> CONTACT INFORMATIORI <br /> OWNER NAME: f� •"� ; y'l�(�� ��� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srREET /�� ��� �'���r ��-�� ��;J � ��l p t,�� <br /> CITY � ,I �.���: �� STATE . ZIP ��)G � �^ <br /> � �� <br /> OWNER PHONE: S.J fv��' C '`� <� � �� FI. OWNER EMAIL:5 �'.I , : � u`�'� ����� sj� f'� ��'�c� � ; `�GJ �� <br /> CONTRACTOR NAME: (�,��� 1 ` � � � `���� 6'�: , `�'� "(~ �� <br /> CONTRACTOR ADDRESS: sTReeT j? �4 ' <br /> s� <br /> , <br /> CITY � ? �I�`�'� STATE ZIP � � � C� <br /> CONTRACTOR PHONE: , �� --���1 � CONTRACTOR EMAIL: �' ry; P? J, 9 � � � ' ' _�, (�� �� , <br /> CONTRACTOR LICENSE#(RECIUIRED): �'� �`�� ���� � � �-� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ' � ��1� <br /> PRIMARY CONTACT: ❑ OWNER .�CONTRACTOR ❑OTHER(Please Specify) ��j 2�'� <br /> CONTACT NAME: CONTACT PHONE: sq'"�`�. °�,,7'' �� -m ��G� %� <br /> ����Z ���r� �,�/ CONTACT EMAIL: � e = ` � �e <br /> � • �'If� V� � &. � � � � , <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 prinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF ORK: � <br /> Sir��I � �a�r�� �e ��� ���� �J �- � �r� �� ���� �r <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICAT10�1 <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 List of Fixfures #°f Lisf of Fixfures <br /> Fixfures Fixtures Fixfures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bidg) <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 /> SPRtNKLER/SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT`.1 have reviewed this application and confirm the information contained herein is t�ue and correct. Work done pursuant to fhis permit must comply with <br /> current federal,sfate,and local law. The granfing 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 autho�ized under any circumstance.1 am the owner,or I am autho�ized by the ov✓ner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> � r��� � � a <br /> O erlA thorized Agent S ture Date (Revised 5/20/2016) <br /> 'l��. �', <br />