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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 1 FORMATION <br /> PROJECT SITE ADDRESS: G%• � ��C.� PROPERTY TAX#: <br /> LEGAL for new construction: Short lat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: CLti—' - �L��L� � ��" TENANT NAME(If Commer ial): L <br /> OWNER MAILING ADDRESS: sTREEr <br /> 7 � - �' ? �� �'��� �-�/ <br /> v ��' <br /> 'Ll �j TE ZIP � <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME, �/�(/l/ :/�-� <br /> CONTRACTOR ADDRESS: sTReEr y <br /> 'G� /�'GC� c�� � <br /> p�Ty STATE ZIP - <br /> CONTRACTOR PHONE: 2� �� �� �� CONTRACTOR EMAIL: ��«�t-�� �°� ���/`�°�.L�-'L�` � G��� � � "�j <br /> �z <br /> CONTRACTOR LICENSE#( 'C2UIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> _._ _ __ _ <br /> _ __ __ _ . __ _ _ _ _ _ _ <br /> PRIMARY CONTACT: OWNER ❑ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACS NAME: CONTACT PHONE: <br /> ,)�G�L /��j�L!L�"._.J�` CONTACT EMAIL: <br /> ILDING PERMIT APPLICATION <br /> Existing Use of Building: i� � J l �l� C��- Contract Price of Work:$ ���-�G? <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building 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: /L ' <br /> � �" ��Zcr� �j� p�j (�G? (l�'/���`�y�(� ��� ��1�, <br /> /�''�� � f�'�'�r���'�/� <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 #�f List of Fixtures ��f List of Fi�rtures #°f List of Fixtures <br /> Fixfures Fi�ctures Fixfures 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 /> SPRINI(LER/SIJPPRE�Si�FI �1(ST°EIVI <br /> Number of Heads <br /> ACKNOWLEDGEMENT:I have reviewed fhis application and c irm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br /> current federal,sfate,and local law. The granting of a permi nly authorizes approved work and no deviations therefrom.Deviations must first be authorized rn writing from the <br /> Building O�cial before being authorized under any circu tance.I am the owner, or I am authorized by fhe owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 R and OOA WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> � � I <br /> Owner/Authorized Agent Signature Date (Revised 5/20/ 016) <br />