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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 4e7T 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 701P C.� °(G1cnn c> LQ41 I PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: -5- , ( GL, //�� TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET PO ISfj (j %u Q . (? -rQG0 IL-L-6 ti l <br /> CITY CJ' t STATE w l ZIP -yam <br /> OWNER HONE: (,,.- s3•' 1 -T2 OWNER EMAIL: t-y— f(J S G {� od CJw' <br /> C R NAME(/`T�;' C 11' <br /> CONTRACTOR ADDRESS: STREET (��f�� <br /> CITY 0L9-JI STATE fT ZIP <br /> CONTRACTOR PHONE: to 'r-- ,',24_)('^ C- q — CONTRACTOR EMAIL: Lf— 'Ce'� <br /> CONTRACTOR LICENSE#(REQUIRED): {- CITY OF EVERETT BUST ESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 1410WNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: , CONTACT PHONE: 7 ) 3 (aq 2 . <br /> P2 LC -1 t CONTACT EMAIL: <br /> ir'cg � 5 r� yr <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: a LI- ' (,lh CJvA,!h Contract Price of Work:$ <br /> Proposed Use of Building: ���rvru� ACL 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: <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 /> Chemical or Water I No. 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 before being authorized under any circumstance.I am the owner,or I 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 <br /> Everett Official Use Only <br /> PERMIT# <br /> --D <br /> Owner/Authorize v <br /> t Signature Date (Revised 9/23/2016) <br />