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• PERMII'APPLICtr4TION• <br /> �UILDING / MIECHANICAL/ PLUIViBING /SIGN /SPRINKLER/ DEI�IOLITION <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.govlpermits <br /> (�lue or �lack Ink Only Please) PROJECY SITE INFORMATION <br /> PROJECT SITE ADDRESS: �L''�j ' � f- �� � ,,.. �� PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision � �� Lot No. (attach copy of long legal description) <br /> CORITACT IPIPORMATION <br /> OWNER NAME: %� •; � ; TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReer <br /> ciTv srnre ziP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME; - � <br /> CONTRACTOR ADDRESS: sTR - � � �,--. �, <br /> CITY � STATE Z�P <br /> CONTRACTOR PHONE: � 5 " � � ) CONTRACTOR EMAIL: ' ,,• �J cct�jl� > r �r -c�1 r i <br /> /� �� . .�- ./ � / <br /> CONTRACTOR LICENSE#(REQUIRED): �'r�i'�-'/� ��iL �l,%�� � CITY OF EVERETT BUSI SS LICE E#(REQUIRED): � "�l,� <br /> _.�_..... _,__.... _. _..._ _._._.._..._,._.._. .__.__. _ ...... _.. .............. _. ._.__,_ ..._......_ .. _._ _.. __. - ..__ _ __..._. _._...._. . ......_.. _. ....._ ,... <br /> PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: y�'�- "j�j c�— � �� <br /> �— , <br /> � ,- � CONTACT EMAIL: <br /> H., �C` - ��� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> _----� <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: <br /> ,������ ��;��� , - ,�1� � � <br /> , �� ��� <br /> � <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLIGATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #°f List of Fixtures #�f List of Fixfures #�f List of Fixtures #°f Lisf of Fi�rtures <br /> Fi�ctures Fixtures Fixtures Fi�ctures <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 /> ��6�SId�LI�l3/�NJE�PRL�S�LAf�! �VSTLIVI <br /> Number of Heads <br /> ACKNOWLEDGEMENT.1 have�eviewed this applrcation and confirm the informafion contained herein is true and correct.Work done pursuant to this permit must cornply with <br /> current federal,state,and local law. The grantrng of a permit only authorizes approved work and no deviations therefrom.Deviafrons must first be authorrzed in writing from the <br /> 8uilding Offrcial before being authorized under any circumstance.I am the owner,or I am authorized by the owner of thrs properfy fo perform the work for whid�application is made, <br /> and 1 comply with the State Contractors Law 1II.27 RCW and 296.200A WAC. <br /> City of Everetf Official Use Only <br /> / _�� Y� - PERNN� I �� ( � _' ��- <br /> / �'� <br /> Owne AuthonaetNAgent Sign t e ; Date (Revised 5/20/2016) � <br /> �, ` J <br /> �� <br />