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� PERMIT APPLICATIOf� <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EV 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: ���(�,j .j f �V"i�`t /�l'f/i Li.��- j'�.n{C � PROPERTY TAX#: z�V_I(;- i)�-7`��1 y/U(,+ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. _ (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �UQ 4^�� /'ICr �I I I L GC TENANT NAME(If Comm rcial): � �' /C%„ b�' O�� � <br /> OWNER MAILING ADDRESS: srReer IJQ��c� C�ci b) �/ ac, j G�C`, � L � i/ T i'o'� l (��'hc " <br /> � � <br /> S(�,i - �� CITY ��+'�^ ,� �c�� STATE �,� ZIP '�,ZQ � <br /> OWNER PHONE: ��-� z.Z-,��Ol) OWNER EMAIL: L `y1��' �IC!��i' = I�'ICi'r�(' ��,(OC4�' Pc,y; l�1.r <br /> CONTRACTOR NAME: S /ifC�T • ' J J 'c' v�J <br /> CONTRACTOR ADDRESS: srReeT / 1/�/ � — f <br /> CII�Y � , STATE ZIP q / <br /> CONTRACTOR PHONE: z CJ(j - � Z Z-, ,Z U � CONTRACTOR EMAIL: /2//p(,Q C/J� t- ;�y[y�(� , C(j' <br /> CONTRACTOR LICENSE#(REQUIRED): S I �1�1 ,l� �I�S � L � CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2 '� ,�, � ,Z Z = ,ZC+ <br /> ` 'G�� i '�C/C,�C��/1/j v� CONTACT EMAIL: d.��; . L �' , a 3 . L C% r� <br /> � C� � �-t= c � �; -1 � <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ L� e '��.G <br /> Proposed Use of Building: Heat Source: ❑Gas �7Electric ❑Other <br /> Buiiding Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: „ <br /> ��3�fu l/ ,�;��e�� / ��f7`��� <br /> f�d�c, <br /> (�� ���r�1 �s� e � ���� <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 /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures 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 /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and r.on(irm the in(ormation contained herein is true and correct. Wo�k done pursuant to this permit must comply with <br /> current federal,slate,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must(irst be autho�ized in writing(rom the <br /> Building Official before bciny authorized under any circumstance.1 am the owner,or 1 arn authorired by the owner ol this property to peAorm the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and'196.ZOOFl WAC. <br /> City of Everett Official Use On/y <br /> PERf)4ll# _ � � <br /> /�' �i �� '�� � � <br /> � c.�z, <br /> wnerlAuthorized Agent Signature Dale (Revised 9/23/2016) � ' <br /> /Z <br />