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� PERMIT APPLICATIO� <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN / 5PRINKLER/ 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� wwvd.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: C, .P� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> q <br /> OWNER MAILING ADDRESS: sraEEr <br /> o a <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: � -e � <br /> CONTRACTOR ADDRESS: sTReeT '� (_ <br /> CITY STATE 21P �' �O� <br /> CONTRACTOR PHONE: - - � r] CONTRACTOR EMAIL: j Q f(��T � 1 ��-6�l <br /> CONTRACTOR LICENSE#(REQUIRED): � �ELI,E ����/ IC CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): � q� <br /> PRIMARY CONTACT: ❑ OWNER 1 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: �,�e�Ur-�X- CONTACT PHONE: �a„5_ 5�,_ Ia,�-� <br /> CONTACT EMAIL: ���e • ° ��� <br /> r <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:SnS�A���j.�10'(l b� /�c'RSU� ��Qa S�S'ffX�(1 -�p C'��`(�(A, �lQ(1•-I�L�J�Q <br /> `R.c�.no�e �-�vc�.�d s�sk-em1 �� �� De`� . <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 Lisi 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 /> N umber of�leacis N O�C, <br /> ACKNO6NLEDGEMENT:I have reviewed this application and confirm the info�mation contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current(ederal,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 the owner,or I 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 OHicial Use Only <br /> PERMIT#� � <br /> ��.��� �,�� llCo � ' <br /> OwnerlAuthorized Ag Signature Date (Revised 5/20/2016J <br /> �lz <br />