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PERMIT APPLICATIC <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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ��O ��.p � Eve✓'� Zb PROPERTY TAX#: (}Q(pq ( p(�('j pQ <br /> LEGAL for new construction: Short Plat/subdivision !► � # Lot No. 27 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: � TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReEr a 3 t�N Ldh e. <br /> CITY � � STATE �Jr ZIP Q� <br /> OWNERPHONE: ZS '��J ^ 7Q(� OWNEREMAIL: � (�S /f'� p�dC�•Go� <br /> CONTRACTOR NAME; e p/� <br /> CONTRACTOR ADDRESS: srREeT 7Sq �� � 5f <br /> ��n vi 1 � sTATE Z�P �.7 <br /> CONTRACTOR PHONE: — '; — Q y CONTRACTOR EMAIL: (�Q Cd GT/ O l 1".Cd <br /> CONTRACTOR LICENSE#(REQUIRED): 7S CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): vS Zy <br /> PRIMARY CONTACT: �OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Z,S'��'�Z ' O b <br /> CONTACT EMAIL: K d T L SM Od •C�O <br /> BUILDING PERMIT APPLICATION ""� <br /> Existing Use of Building: � �� Contract Price of Work: $ '� 8 O(,� � <br /> Proposed Use of Building: �G I d eN Heat Source: ❑Gas � Electric ❑qtKer <br /> Building Type: ❑SFR-Detached �SFR-Attached ❑Duplex ❑Multi-Family-#of Units: �' _ �eommercial ❑Industrial <br /> Type of Project: ❑New ddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 1 <br /> ��d)7-!(JN (� f'le(� b�P✓?lO h� �N� G�O S�� <br /> !� <br /> ASSOCIATED BUILDING 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 /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <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(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT:l 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 before being authorized under any circumstance.I am the owner,or 1 am authorized by the owner 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 Oflicial Use Only <br /> � �� �I7 P IT��� D�� <br /> Owner Authoriz d Agent Signature Da (Revised 9/23/2016) <br /> � <br />