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• PERMIT APPLICATION • <br /> BUILDING / MECHANICAL /PLUMBING !S(GN / SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8B57 j��j everetteps@everettwa.gov� www,everettwa.govipermits <br /> (�1ue or Black lnk 4nty P1+ease) PR{3J�GT�IT� INPQ�tMATIt�N <br /> �'F�OJECT SITE ADDRESS: ��}�,`� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivislon Lot No. (attach copy of long legal description) <br /> CClNTA+CT tNFORMA'1'ION <br /> t7'vVh1ER NAME: �'"� TENANT NAME�if Commercial}; <br /> C7WhiGR MAILING ADDRESS: ,r��rT �,,�i �, <br /> �w �'�'�{ STATE ZIP ,� <br /> OWNER PHONE: � �, OWNER EMAIL: <br /> CQNTRACTORNAME: �-��,(C}"���- <br /> C�3NTRACTOR ADDRESS: sraeET �1� (� <br /> �r�' sraTE �,t�' ziN —I���� <br /> CONTRACTOR PHONE: � � CONTRACTOR EMAIL: (,��{�,���, + G�I�{(,`��"j✓�� � (Q�.y°� <br /> CON7l�ACTt7R LICENSE f�(E��GUIRE�}; C,,,(Y1V'('C�.1�"�,�('t�r]Zd}'"� CITY OF EVERETT BUSINESS LICENSE/t(REQUIRED): �(pC�j�,y <br /> PR[MARY CONTACT: ❑ OWNER �CONTRACTOR ❑OTHER(Please Specffy) <br /> � <br /> CC7NTACT NAME: � CONTACT PHONE: � ��� �'"� <br /> �J�/{,1.�..s.�..Q,.� CQNTACT EMAIL' ���J I� C�Y1��GL�'1� •t0 M <br /> I3�iL�I1Vi3 F��t�(t��T,AP�Li�:�1'�'tC)F+� <br /> '�xistinr Use of Buildin : Contract Price of Work:S � <br /> �'ropo>eci Use of Builrlin : Heat 5ource: ❑Gas �lectrl� ClOth�r <br /> �uiiding Ty�e SFR-[��iach�d ❑SFR-Attached ❑17u�lex ❑Multi-Fami! -4#of Unais: ❑Commercial ❑Industrial <br /> �"y,�c�of Pr�j�acl; �New ❑Addition ❑Remodel ❑���air ❑T.I_ Cl�igrv USprinkler ❑Demofition ��hangs of Use <br /> �pESCRIPTION OF WORK: ���� ��SS � �� <br /> r <br /> �AS50CIATED BUILDING PERMIT#(it��pfir.aGl�}: <br /> MEGFIANiCAL PERlUIIT ARPLiCAT1t�N PLUMt3�NG P�"FCMIT APPLICATIl7N <br /> Type of ProJect: New Addn Alteratlon Repalr Type of ProJect: New Addn Alleratlon _Repair <br /> #of Llst of Flxtures #of � #pf #of <br /> Fixfures Fixtures Ust of Fixtures Fixtures ��st o/Flxtures Flxtures Lis!of Flxfures <br /> A/C-Air Handlin Units f Heat Pump Toilet Backflow Preventer(Inside Bld 1 <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refri eration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ductin Dishwasher Roof Drafns <br /> Cfothes C�ryer Hookups Other, Clothes Washer Medical Gas <br /> Range Hood Water Heater other <br /> Exhaust Fan Sink(Service/8ar/Mopletc. Other: <br /> SPRINKLER 1 SUPPRESSIUN �YSTEIt+I <br /> Chemical or Water No, of Heads <br /> nCKNOWLEDGEMENT:I havo�eviewed lhis appticafion and confinn the in/ormaiion con(ained herein is trve and correcL Work done pursuan!fo this permit must comp/y wrth <br /> current federaf, state, and local faw. The granting ot a permif only authorizes approved woik and no dev/aflons fherelrom.Devlatlons musl flrst be authorized in wnting/�om tho <br /> Huilding Oflicial before 6eing aufhorized under any circumstance.I am tha owner,or 1 am aufhorized by the owner o(fhis p�operty(o perfoim the wo�k/or whlch application is maae, <br /> and t comply wilh fhe Sfate Contractors Law 18.27 RCW and 296.2COA WAC. <br /> i�r'ty o1�verett Officiel Use�tn1y= <br /> PERMIT# <br /> �� j�- l0• 0 •1 '�'�, 1 � � <br /> �4wne IAulhorized Rgen ignature bate (RevlsAd 9/23/2t716) <br />