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. PERMIT APPLIC�N <br /> BUILDING / MECHANICAL / PLUMBING / Sll�IV / 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 /> (Blue or Black Ink Oniy Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: � ` P � r�� \�j� ��� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �n ��p� �N..r _�, �, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReer � � � ,J �;t� • <br /> \ ,. ��� l. <br /> CITY `�. \ '\Q ;\ STATE '� ZIP <br /> OWNER PHONE:�� " OWNER EMAIL: �. ; •� � � ,p 5��;. . . � ''\ <br /> CONTRACTOR NAME: �'`„ ' �� • � ��C,L� � c� <br /> CONTRACTOR ADDRESS: sTReer� ' t� l�' L�y C,� <br /> CITV� � �� �i STATE C ZIP C 1,� <br /> CONTRACTOR PHONE:�^ �;, C� CONTRACTOR EMAIL: ^ Nm` � �- (V� <br /> CONTRACTOR LICENSE#(REQUIRED):����� ' CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): �� <br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: ��y�. CONTACT PHONE: "� , <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATtON <br /> Existing Use of Buildin : �," � Q,,�(.,, Contract Price of Work:$ <br /> Pro osed Use of Buildin : Heat Source: ❑Gas ❑Electric ❑Other <br /> Building T pe: ❑SFR-Detached OSFR-Attached ❑Duplex ❑Multi-Famil -#of Units: ❑Commercial ❑Industrial <br /> T pe of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Si n ❑Sprinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: ('ti <br /> ��_V�`��� �' 1�: <� �` ��:c�c�`c�� �� <br /> � ��/� /',,��/� <br /> ASSOCIATED BUILDING PERMIT# if ap licable): '"(/Y t � (� ��Y� 1 <br /> MECHANICAL PERMtT APPLICATION PLUMBING PERMIT APP ATION <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 Fixiures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bld ) <br /> Forced Air S stems 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 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(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.I have reviewed this application and coniirm the information contained herein is true and correct. 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 writing from the <br /> Building Official before being authorized under any circumstance. 1 am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> a /y wrth the State ontractors Law 18.27 RCW and 296.200A WAC. <br /> \�, City of Everett Official Use Only <br /> � PERMIT# <br /> i� �� �� ' � ' ��d�-d0� <br /> Ow er/Authorized Agent Signature te (Revised 9/23/2016) <br />