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• F'ERMII'APPLICATIO�
<br /> BUILDING / MECHANICAL/ PLl1MBING / SIGN / SPF211VKLER/ DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> EY 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 INFORM,ATfON ' ; ; ;
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<br /> PROJECT SI E ADDRE S. �,. �,_ � i ;,. PROPERTY TAX#:
<br /> '�`�l t.� ��,;�� � �� b`�' -is C�'.y � �`�".�3
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<br /> LEGAL for new construction: Short Platlsubdivision Lot No. (attach copy of long legal description)
<br /> ,CONTACT IPrFORMATION ,
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<br /> OWNER NAME: C�.: O`r'�`� � 1��,! ' ' � TENANT NAME Qf Commercial): '—'�`
<br /> OWNER MAILING ADDRESS: sTReeT � ' , �" � '`
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<br /> C�N � �' � STATE
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<br /> OWNER PHONE: ,- b� .. • ' _G`, _ ;,3 �" �-� OWNER EMAIL: C� I ' V�� � �<':, < , G�. , f Y I
<br /> __ .. . , . . .__.
<br /> CONTRACTOR NAME: � � I 1�� � `'�
<br /> CONTRACTOR ADDRESS: sTREEr
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> >.: .
<br /> PRIMARY CONTACT: �'OWNER ❑CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT PHONE: �,,: � ' - r �'��
<br /> CONTACT NAME: ' _�� ��' r ' ' �
<br /> ��� `" s � r ���� �!� ,���'�- CONTACTEMAIL: ' 3 . ', - , ' ..-�� L ��i �L�� - �+'"� � �,�
<br /> ��' �i_�"`� ��(�� \ f E -0►��, �� �. I�GC1�' i��� 64
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<br /> ' BUILDING PERMIT APPLICATION '
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<br /> Existing Use of Building: ��t"� Contract Price of Work:$
<br /> Proposed Use of Building: 1�1,^l..`��' x- Heat Source: ❑Gas ❑�lectric ❑Other
<br /> Building Type: ❑SFR-Detached FR-Attached-�j C�uplex ❑Multi-Family-#of Units: ❑Commercial ❑industrial
<br /> Type of Project: ❑New DAddition I�Remodel ClRepair L7T.1. L�Sign OSprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: - � "` �
<br /> ��,►-.� V"'�,��^� �'� ,��r'"=�,,�`� .,�-�_'�'`�`� (�.��� ��� � ���`
<br /> � �(/'�� ��c1�%'���-7;�i�' �T� G�;�cr-�'�
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<br /> ASSOCIATED BUILDING PERMIT#(if applicable): ���� �r?����uN� t 2�—�
<br /> MECHANICAL PERMIT APPLICATION' PLU'MBING PERMIT:APPLfCAT10N
<br /> Type of Project: _New _ Addn Alteration _Repair Type of Project: _New _Addn _Alteration _Repair
<br /> #of #of #of List of Fixtures #of List of Fixtures
<br /> List of Fixtures List of Fixtures Fixtures
<br /> Fixtures Fixtures Fixtures
<br /> A/C—Air Handling Units Heat Pump ( Toilet Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater I 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&Disposai 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 correct Work done pursuant to this permit must comply wifh
<br /> current federal,sfate,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 /> Buildi Offic before being authorized under any circumsfance.1 am fhe owner,or 1 am authorized by the owner of fhis properfy to perform the work for which application is made,
<br /> an compl with the State Contracfors Law 98.27 RCW and 296.200A WAC. Cify of Everett Official Use Only
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<br /> , ,J �^ M I� �. - � � PERMIT# � • .\ ' �
<br /> ��' U 1 r v�.r,�'�v �� � `� � � � lJ
<br /> d /�
<br /> "� Date (Revised 10/12/20i5)
<br /> Owner/Authorized Agent Signature � �
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