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• PERMIT APPLICATION • <br /> BUILDING/ MECHANICAL/ PLUMBING !SIGN /SPRlNKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8657 �(E)everetteps@everettwa.gov� www.everettwa„g�vlp�rrttils <br /> (131u�or Black Ink Onl�Pleara��� PROJECT SITE INFORMATMtiN <br /> F*t�t7JE�T SITE ADDRESS: G��I ` C�C�lL�C�-�-� �..r PROPERTY TAX#: <br /> �.EGAL far new construction: Short Platlsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATIdN <br /> OWNER NAME: �„� {',,t ` I�.�2.. (�Q �'",� TENANT NAME(If Commerciat): <br /> t�WNER MAILING ADDRESS: srREEr ,�- t �,�� � <br /> �� STATE ��'" 21P -1 8�Q <br /> OWNER PHONE: �O�o �LZp t7',.�'''�� OWNER EMAIL: <br /> CONTRACTOR NAME: �'^��,'{/,.�"'['���-` <br /> CONTRACTOR ADDRESS: sraeer ��,� (� , <br /> ....... �� �: . STATE � �� ZIP �.�t...,l��� <br /> CONTRACTOR PHONE: (� CONTRACTOR EMAIL: �', (�� C�('�r'j�.�'�►� . C„�y.y� <br /> �01�1TRA�TQR LICENSE#�F{E(�t11REp):�{Y"��`�}'1�'�,���ZdF� GITY OF EVERETT BUSINESS LICENSE#{REQUIRED): tCpC��t <br /> PRIIV�AE�"�CONTACT: ❑OWNER (�CONTRACTOR ❑OTHER(Please Specify) <br /> CCtN7AC7 NAME: CONTACT PHONE: � �C�� �'��j <br /> ► � L�...1��� GOFt7AC`�EMAII� ��1'�'�ry C�VI�i�"'�'1'►� •�0 M <br /> BUILDINl3 PERMlT A�PLtCAT10N <br /> Ex3siin�Use of Buildln : Cpntract Price of Work: ; 1. �� <br /> Pro osed Use of Building: Heat Source; �as ❑Electric ❑C}#h�sr <br /> �uiidin T a: FR-Detachad ❑SFR-Attached ❑GYu lex ❑Multi-Fami1 -#ofUnitst ❑Commercial ❑Industrlal <br /> 7 �of�'ro's�t: ❑New ❑Addition ❑Remodel C�Re air ❑T.I. ❑Si n QSprinkler ❑Demolition ❑Cha�t �of Use <br /> E?ESGRlPTIfJN OF WQRK: <br /> � �.� Lfo�� G�a-S �i <br /> ASSOCIATED BUILDING PERMIT# if a piicable : <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn _Alteratlon Repafr Type oF ProJect: New Addn _Afteretion Repair <br /> Fixtures Llst of FJxtures Fixtu es Llst ot Flxtures #°� Llst o/Flxfures �°f Llst of Flxfures <br /> Flxtures Flxfures <br /> AIC-Air Handlin Units Heat Pump Toilet 'Backflow Preventer Inside Bld ) <br /> Forced Air Systems Unif Heater Bathtub Urinal <br /> Gas Pipin Boiler Lavato Wash'Basin) Drinkin Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kifchen 5ink&Disposal Grease Tra <br /> Gas Ran e Ductin Dishwasher Roof drains <br /> Clothes D er Hookups Other: Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink lService/Bar/Mop/etc. Other. <br /> $PRINKLER/SUPPRESSit3N SY8tEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•!have revlewed Ihis appllcation and conilrm fhe!n/ormation contained herein is lrue and conecl.Work done pu�suant to this permr�musi comply with <br /> cuirent federal,state,and local law. The granNng of a permll onty authorizes approved work and no deNaHons fherefrom.Devlal(ons must flrst be authorized in writrng from fhe <br /> Buiiding O�clal 6e/ore being aulhorJzed under any circumstance.I am�he owner,or 1 am aulhoAzed by the owner of this property to peAorm the work for whlch application is made, <br /> and I comply wilh!he State Conlractors Law 18.27 RCW and 296.200A WAC. <br /> City ot Everett O/ficial Use Onfy <br /> �I� 1��"v�pC ,,..�t— PER #� <br /> ;�� 3�z ��� �1 - ��C� <br /> dwnerlAutharizetl Agent Signature Date (Revised 3✓23/201G) <br />