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• • ' <br /> PERMIT APPLICATION <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PEKMI7 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 /> _ ; <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:�2�ja T�' f l� � � L� PROPERTY TAX#: i <br /> -� i <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION i <br /> OWNER NAME: ��"l� � �`1 i��Y1 1��:_ �' TENANT NAME(If Commercial): '� <br /> OWNER MAILING AD�RESS: srReer � � 'ti �L,�; j;7•,� ; <br /> CITY �=��J•T�e,.�t'�'� STATE L�.�� ZIP 9 U a ',,, <br /> OWNER PHONE: ' OWNER EMAIL: <br /> CONTRACTOR NAME: 1 I <br /> �X7L`�-�/1 IiU�„t" i N c. <br /> CONTRACTOR ADDRESS: srReEr p��� � _ t,V � R, �- <br /> i <br /> 1 <br /> cirv �� srnTE L�.1� ziP � �J <br /> CONTRACTOR PHONE: �C�� 9��� J~J�� CONTRACTOR EMAIL: - <br /> 1 <br /> CONTRACTOR LICENSE#(REQUIRED):�#} _� 'l��f-)i,`S�I�CL��J�C(p CITY OF EVERETT BUSINESS LICENSE#(REQUIRE : <br /> PRIMARY CONTACT: ❑OWNER Cl�'L�NTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME:�y-c.,tiG�/' j.�j�E' ���.ru% CONTACT PHONE: �f� ���=j -y��-� <br /> CONTACT EMAIL: _ -�,�C,i—. � l E_�_F.�: ' ;L�jL�;C-= y1-'� <br /> ` BUILDING.`PERMIT APPLICATION ` <br /> Existing Use of Building: Contract Price of Work:$ � ��- c�'(�`` <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other j <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex C9iVtaiti-Family-#of Units: �Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel �4Repair ❑T.I. ❑Si n ❑S rinkler ❑Demolition ❑Change of Use � <br /> DESCRIPTION OF WORK: Q _��` ����. �Nti�� � ���� � p_ U� �� �r „ ` <br /> r,�6� vt,� v� ;. <br /> �J ° <br /> _ <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 °f List of Fixfures #of List of Fixtures <br /> Fixiures Fixtures Fi ures Fi�ures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bidg) <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 /> Number of f leads �� <br /> ACKNOWLEDGEMENT I have reviewed this applir,ation and confirm the informafion contained herein is true and cor�ect.Work done pursuant to this permif must comply with <br /> currenf federal,state,and loca/law.The granting o/a permit onty authorizes approved work and no deviations theref�om.Deviations musf first be authorized in w�iting from the <br /> Building Official before being authorized under any circumstance.!am the owner,or 1 am authorized by the owner of this property to perform the work fa which application is made, �,�i <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WFlC. �� <br /> City of Evereft Official Use Only <br /> P # s <br /> �r� �o 02� !'7 *' 0 :; <br /> Owner/Authorized Agent Signatu e 'Date (Revise 10/12/20 5) � <br /> � <br /> � <br />