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� PERMIT APPLICATION� <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER / 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 /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: �L - � " OP�RTY TAX#: <br /> l'�C..� -�1���,���'� 6� �.. <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: � -�-�'1 � .�.�•� - 4� `; --� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sraeeT `1 � � �--- �-��- �--(.,y� � .�_. <br /> CITY '�,'�J�l/V��� ... STATE �'� �� � ZIPC� �--� �'�`-'._� <br /> OWNER PHONE: �� �" �-''� �' � � j Y OWNER EMAIL: �_ �(,;'� <br /> CONTRACTOR NAME: ��� �f � �l—Y vvc.�� <br /> CONTRACTOR ADDRESS: sraeeT �, � t,� L.Z•�.�^ �"�`�" e�S�/'u' {% " � <br /> ciTv � STATE �,�%� � ziP � � ��I_� <br /> CONTRACTOR PHONE: � Z � -� � � I r CONTRACTOR EMAIL:,��, S ('� <br /> CONTRACTOR LICENSE#(REQUIRED):^�����' �� ' � � �,�"� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED�-����� � �` <br /> PRIMARY CONTACT: ❑ OWNER 0, NTRACTOR ❑OTHER (Please Specify) <br /> CONTACT NAME: - CONTACT PHONE: I. � ` <br /> . � � C, <br /> ��� �� �� � , <br /> / � �f �G t. L � �� l,l��:�� r L- CONTACT EMAIL: �Y� �<` - 'l`'-C Lt.�-�'v�-�' C. .✓v�'tCv f � �,:s:i"`'1 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ � �.�'� <br /> Proposed Use of Building: Heat Source: as ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached L�FR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Pro'ect: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: <br /> w q � _ <br /> f4 `,�'_�?` i e.'-� t'�!� '� ✓��� �'�'l.v'�\,".�'��._ r--'\..'`6�—c-..���� �j'l_.�1,� �'___ <br /> � s <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn �Alteration Repair Type of Project: New Addn Alteration Repair <br /> Fi�ctures List of Fixtures Fixtures List of Fi�rtures #of List of Fi�ctures #of List of Fixtures <br /> 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.I have reviewed this application and confirm the information contained herein is true and cor�ect. 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 wrding f�om the <br /> Building OHicial before being authorized under any circumstance.I am the owner,or l am autho�ized by ihe 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 OHicial Use Only <br /> ` �. PERMIT# <br /> ,- --. � ,---' ���. C 1 �-''i I ' � l;� - �`� <br /> Owner/ uthonze Signature' Date (Revised i0'/12/2015) <br /> � <br />