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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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: � O Z-C� �.iU >�>•,r�:; PROPERTY TAX#: <br /> LEGAL for new construction Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �� �Lr�l,`�,��c>�;��C (�L� TENANT NAME pf Commercial): � • <br /> OWNER MAILING ADDRESS: sraEET 'L�G ` P�Gt..S�Lz..i/� � �V��� � � <br /> CITY S 1 STATE �� ZIP ��� Z` <br /> OWNER PHONE: ���j •L��j '—I�j% OWNER EMAIL: r'���;^,;�t'�-� .� C�X�XY�CZ+'Zr'� , �j� <br /> CONTRACTOR NAME: �y`'}�� S c �� `Y�C, . <br /> CONTRACTOR ADDRESS: sraeeT �r}� S, �Y'�=(�'�OLC=�Y� '� <br /> CITY S "��(� STATE ` � ZIP �t <br /> CONTRACTOR PHONE: � � �Ql •�-V�J�- CONTRACTOR EMAIL: �C(����(�i>� C�S-C��..J� <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER .�CONTRACTOR ❑OTHER (Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ��. ��j l, �'jS� <br /> �U„$4 M��i'�� CONTACT EMAIL: j�`-�J C� �'���,,� t ti'�S � LF� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ �� 5 GCi � <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Buildin Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ulti-Family-#of Units: (5� ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: � <br /> / •—/�C-i.�n �I�.'�`h T� tn <br /> J <br /> ASSOCIATED BUILDING PERMIT#(if ap licable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn Alteration Repair Type of Project: New Addn Alteration Repair <br /> #of List of Fi�ctures #of List of Fixiures #°f List of Fixtures #�� List of Fixtures <br /> Fixtures Fixtures Fintures 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 /> Chemical or Water No. of Heads <br /> ACKNOWLEDGEMENT.�1 have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply wdh <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 Officia/before being authorized under any circumstance./am the owner,or 1 am authorized by the 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 296200A WAC. <br /> Ciry of Everett Official Use Only <br /> PERMIT# <br /> . g. � - -�-- o — (�20 <br /> e uthorized Ag t Signature Date (Revised 9/23/2016) 1� 1 <br /> l �; <br />