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� PERMIT AP�LICATION � <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER/ DEMC)LITION <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 Biack Ink Only Please) PROJEGT SITE INFOR�tIAT10N <br /> PROJECT SITE ADDRESS: "' (� �; �"���i�-f=-L��� � ���--' PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. _ (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: -�1�.�4��,�' '.�`L�.�--(,�, TENANT N,4ME(If Commercial): <br /> OWNER MAILING ADDRESS: srREEr � �( � �" ��.�'-�.� l.v+�> <br /> CITY �. %2�� STATE �j`;��. ZIP � �?-L�1 <br /> OWNER PHONE: � ;•�j`�(f% - �I�I�' OWNER EMAIL: <br /> CONTRACTORNAME: �t_,{'E��r� '� � ���1,1 ��V' '�� ��i��l,C_.�C:YI S <br /> CONTRACTORADDRESS: srReET (�'(`� � L, ' C � <br /> � " � � � <br /> CITY �.�—L� �.��,�,,,� STATE 1/�v� ZIP � L.��� <br /> CONTRACTOR PHONE: ��iG��'��'j `1�O�_. CONTRACTOR EMAIL: � /� � -il. � '��'CY�1 �1����� � C C�� <br /> CONTRACTOR LICENSE#(REQUIRED): F'f'\K--�C1�C��� '�jZ'1'"�T CITY OF EVERETT BUSINESS LICENS #(REQUIF:ED): ���,'jL�� <br /> PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME� CONTACT PHONIE: aj�,�i .�-�j- `�dSt'�'C� <br /> �r� ,� �-i`�����, �,,�� � .1-.� <br /> °.,��.1LJ�.. �4-�iulA�f'l CONTACTEMAIL: �� ���j°:��� �'Z��'�1� �C.� )r � � C"',���'v�1', <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ 1 t�'r'r' <br /> Proposed Use of Building: Heat Source: �Gas lectric ❑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 /> ��'E�VQ/ ���t�LLL-� �`Lf=� �-L Y L_f/l �'t-/��, <br /> . � <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATI�DN <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #�f 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 /> 1 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:I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this pennit must comply with <br /> current federal.state,and local law. The granting of a permit only autliorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building OKicial before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> a d I mply, i the ate Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Eve�ett Official Use Only <br /> PERMIT# /} �^ <br /> i <br /> �� I� ((� � � � � /� <br /> Owner/ uthorized gent Signature Date (Revised 9/23/2016) <br />