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� • <br /> PERMIT APPLICATION <br /> BUIL.DING /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� wwvd.everettwa.gov/permits I <br /> PROJECT SITE INFORMATION ' i <br /> PROJECT SITE AD�RESS: .� / PROPERTY TAX#: � <br /> GU L�� � <br /> LEGAL for new construction: Short Plat/subdivision Lot No.__ (attach copy of long legal description) � <br /> i <br /> ! <br /> CONTAC7 I NFORMATION <br /> i <br /> OWNER NAME: �y TENANT NAME(If Commercial): ; <br /> OWNER MAILING ADDRESS: srReEr �E�G �L� A V e. II <br /> CITY �j� STATE ZIP ? ,�➢ I <br /> OWNER PHONE: Z O� �j �j� OWNER EMAIL: Y' �ej Y C! I <br /> I <br /> CONTRACTOR NAME: p �1 � �� <br /> -� i <br /> CONTRACTOR ADDRESS: sTaeer � �j � ��' <br /> i <br /> ciTv ' •� �'/C-�--.� srnre l'J�` ziP I�G�'7C.� I <br /> CONTRACTOR PHONE: �,5 ',��j '��;>Z� CONTRACTOR EMAIL: z c .✓�f,Y� - ; L � <br /> i <br /> CONTRACTOR LICENSE#(REQUIRED): �L� Q�� j—F�!} �� � ,�lti CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): L /� � <br /> PRIMARY CONTACT: ❑OWNER �`CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: LjL� — j ��..� t= <br /> �.:, 7y�L <br /> I�k-'��� �,}.1 �`:�-���-`�- CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ / �"%!°� � ' <br /> i <br /> Proposed Use of Building: Heat Source: as ❑Electric ❑Other � <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: �Commercial ❑Industrial ; <br /> Type of Project: ❑New ddition ❑Remodel ❑Repair ❑T.I. ❑Si n ❑S rinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: \ � f <br /> f�'1�-� fTCC �-a �:,.�.)n 5��'E��fL-S C���`�.:'\�„v. . ��,'�' 1>.:i`f� i.:�,� �-i: <,t, r;�l i?i�'�� ; ; <br /> � <br /> i <br /> ASSOCIATED BUILDING PERMIT#(if applicable): G <br /> r <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION � <br /> k <br /> Type of Project: _New Addn Alteration Repair Type of Project: ^New _Addn _Alteration ,_Repair f <br /> #of List of Fixtures #�f List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> FiMures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heaf 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&Disposaf Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: I�S <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads � <br /> i: <br /> ACKNOWLEDGEMENT l have reviewed this application and con/irm the information confained herein is true and correct.Work done pursuant to fhis permif must comply with t <br /> current federal,sfate,and locallaw. The granting of a permit only authorizes approved work and no deviations fherefrom.Deviations must first be aulhorized in writing Irom the <br /> Building O(ficial before being authorized under any circumstance.l am the owner,or!am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply_ ' he State Contractors Law 18.27 RCWand 296.200A WAC. I' <br /> h <br /> Ciry of Evereft Of(icia/Use Only F <br /> /j� PERMIT# ; <br /> '� �li� �'�l- � /✓u l 7 iJ `��d �v, <br /> wner/Authorized Agent Signature Date (Revised 10/12/2015) <br /> ��i% �� <br /> � <br />