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� PERMIT APPLICATIO� <br /> BUILDING / MECHANICAL I 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/qermits <br /> (Blue or Black InEc Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: � � '�` �� �Z. ��(� PROPERTY TAX#: Q�`� ���'�(��/� <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �-IZ.J (�� /�- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srREET ���Cp �� L� �,�,,, <br /> CITV _� STATc t�� /� ZIP <br /> OWNER PHONE: J , (��G% OWNER EMAIL: I�JT���(,��d�,�/ �� f�%�C> .�� <br /> CONTRACTOR NAME: � ��f f �� � f�L,.._ <br /> CONTRACTOR ADDRESS: sTREeT f � � � �i/�.�� ` �--. <br /> cirv �y�J' f�1 a �T�TE ziP �j��'GC� <br /> CONTRACTOR PHONE: �� ��j�J" � � CONTRACTOR EMAIL: � Vy1� G�(f��� ,C-��'I/� <br /> CONTRACTOR LICENSE#(REQUIRED): hI VI/� L�(7'L�(6��j.JC. CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): � 1 <br /> PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR THER(?lease Specify) <br /> CONTACT NAME: CONTACT PHONc: � � r'�' '� — "�� <br /> �.�s�J <br /> ��/I � (/�� [• �L�fi��A CONTACT EMAIL: �(;��.�yyj���ff'�y�j�(_y��c7�,n <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: � �_ Contract Price of Work: � ���' � <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 epair ❑T.I. ❑Sign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION F WORK: ' <br /> �/� � � �-�-�,� ��„' <br /> -��- �� � l (s� ��111J L� `-= �' � <br /> � <br /> �f�i c.�' /-�i�-�z 2� �=�'t"<';� �� ������L;� �i�1�=: ,�L <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PWMBING PERMIT APPLICATION <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #of Lrst of Fixtures #�f List of Fixtures #°� List of Fixiures <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 8 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 /> fJumber of Heads <br /> ACKNOWLEDGEMENT,1 have reviewed this application ana confirm the informafion contarneo herein is true and co�rect. Work done pursuant to this permit must comply with <br /> current(ederal,state,and local law The granting of a pe�mit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumsfance.1 am the owner,or I am authorrzed by the owner o(fhis property to perform the wo�k(or which application is made, <br /> and 1 comply with th State Contractors Law 18.27 R W and 296.200A WAC. <br /> ' � � City of Everett Official Use Only <br /> ..�,�,�,�s� -�r/y...::lX-i.-1 � €RMI # <br /> - ��� C -ti�G�. � �a- <br /> Owner uthorized gent Signature Date (Revised 9/23/2016) / 1 <br /> Z- <br />