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PERMIT APPLICATION <br /> BUILDING �CHANICAL/ PLUMBING / SIGN /�INKLER/ 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: SZ�L '�V� �/'Q (,,.� PROPERTY TAX#:Q03 pp 1 p <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �Vp�� �,�4 Z� TENANT NAME(If Commercial): ��-�- <br /> OWNER MAILING ADDRESS: sTReeT�I91 (1 ��v� <br /> CITY STATE v��Q ZIP � t <br /> OWNER PHONE: �j �{ Z OWNER EMAIL: <br /> CONTRACTOR NAME: � e✓�\QI/( �.IJLv1� 1,�l <br /> CONTRACTOR ADDRESS: sTaEeT � (�� (�►����/( I/\/I <br /> CITY ���VyQ�(�(,� STATE��"�C ZIP �g Z� <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: Z e, v� � Lp <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):Q� (p <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �� �$'� �"i'�� <br /> �\G� x CONTACT EMAIL: � a e �`� _ � <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: [e_ Contract Price of Work:$ � b•�fl <br /> Proposed Use of Building: �(_ Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial ❑Industriai <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ���e�r C.�,�.� T.Q�,�\,�.. `�P�'�o�1e.��-�-, �',�7�� t� <br /> �i.�e_sp.�e � �-�l �L��«.. �.�. �1����. . L�ve_� � ���.�c,w� <br /> .�� ��D��� �� � � <br /> ASSOCIATED BUILDING PERMIT# if applicable): �j� �00� ^� Q <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn Iteration _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:1 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 aufhorized 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 O�cial Use Only <br /> PERMIT# � � ( � O� <br /> 1 -� <br /> l� 7 zo.t�6 � <br /> Owner/Authorized Agent Signature ate (Revised 9/23/2016) <br />