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• PERMIT APPLICATION • <br /> BUILDING/ MECHANICAL I PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> 2 Q (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> {Blue or Black ink On leaae) PROJECT SITE INFORMATI�N <br /> PROJECT SITE ADDRESS:�j�' �/�r re�er� �Jcc �I�Y�� PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No.__ (attach copy of long legal description) <br /> CONTACT[NFORMATION <br /> OWNER NAM�: 0 G "fENANT NAME(If Commercial): � �"fi' <br /> OWNER MAILING ADDR SS: s�Er Z �/� �'��'t' <br /> CITY � � STATE ZIP � 22,� <br /> OWNER PHONE• O �p-� OWNER EMAIL: rl h <br /> CONTRACTOR NAME; � e�j � <br /> CONYRACTOR ADDRESS: s-rREer <br /> CffY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): '� � � O C�TY OF EVERETT BUSINESS LICENSE#(REQUIRED�: 0���0� <br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) -� C�" �� ` � �, <br /> CONTACT NAME: �ONTACI'�P7HONE: 7)�pD �Q'�(,Q l[.' �-y?�,-7,'=��" �1_��'�; '" �l� <br /> S�d Gr I G�Q.I�I S�,F� CONTACT EMAIL: �n hW�� • � <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Buifding: cc.irt-t— uJ°tS ►�-►�I �� Contract Price of Work:S '2 � r�� �.� <br /> Proposed Use of Buildin : Heat Source: as ❑ElecVic ❑Other <br /> Buildin Type: ❑5FR-Detached �SFR-Attached ❑Duplex ❑Multi-Famil -#of Units: Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition Remodei ❑Repair OT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORKs <br /> re�noc��� cx�s►st-�n9 vaca�,+ e�►tc��n9 ��-ro ��e�fi� oc�;�-e <br /> ASSOCIATED BUILDING PERMIT# if applicable: <br /> MECHANIC/�{.PERMIT APPLiCAT10N PLUMBING PERMIT`APPLICATIbN <br /> Type of Project: New Addn _Alteration Repair Type of ProJect: _New Addn _Alteratlon Repair <br /> #of List of F(rtures #of Llst of Flxtures #�f Llst of F/xtures #of Llst of Flxtures <br /> Flxfures Flxtures F/xtures Fiufures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Fiping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drairt <br /> Gas Firepface Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ductin Dishwasher Roof Drains <br /> Clothes D er Hooku s Other: Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink Service/BadMop/etc. Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT:1 have reviewed fhis application and confirm the information contained herein is fn�e and correct. Work done pursuant to fhis permit musf comply with <br /> current fedsral,state,and/ocal law. The granL'ng of a permit onfy authorizes approved work and no deviations the�efrom.Deviations must first be authorized in writing from the <br /> Suilding Olficial before being authorized under any circumstance.!am the owner,or I am euthorized by the owner of this property to perform the work for which application is made, <br /> and f comply with fhe Stafe Contractws 8.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> •- ' /�/ PERMIT# '^ � �`�I <br /> � / � � V <br /> OwnerlAuthorized Agent Slgnature Date (Revised 5✓20/2016) ' \ <br /> 1� _ f <br />