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1r. <br /> ' � . 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 INFORMATION <br /> PROJECT SITE ADDRESS: f�,��' � '' �= � � ' "����� PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ��{��:�J i';::y` "" TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReer S�^ ��, y'�„ ; L. <br /> CITY r�ere� STATE ✓ :I" ZIP ,�,�'� <br /> OWNER PHONE: `�F,;�;;ti- '�`r--`;,y��= OWNER EMAIL: %'fii;`�.%y� �:'�%��p,�,.�;;,,7 <br /> CONTRACTOR NAME: �_.f. _ ~ _ -- _-��,.�__.��---;� - ��l ��- <br /> CONTRACTOR ADDRESS: sTReEr "'7�=��;`�"+�` <br /> , <br /> CITY STATE {,^. ��.'�-- ZIP ��'��(�(,� �!. <br /> CONTRACTOR PHONE: ;:--�.-�-;-- "";-�;-�`�-9--����=-� CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): - CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: �:.1 OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> ` CONTACT PHONE: ----'-"`' � " <br /> CONTACT NAME: . ,��� ,ji�'d 7 1,,:�T".' _'�r- _ �" - . . �-. <br /> , J .�Y . <br /> -r.-'-__-.__ . . <br /> - - , i; � '', CONTACT EMAIL � <br /> i' �, _ = _ __- _ - -. - ti.--� _ <br /> BUILDING PERMIT APPLICATlON <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: r`r��3 ('��r�� Heat Source: ❑Gas QElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: �3New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ;ODemolition - �fhange of Use <br /> DESCRIPTION OF WORK: L�-���/�'C� f��� t�c'�/°b� -' /Lfd �'Lt�f�ll��'1 � 1�r�� h�c/�G'ci-¢/f C, � <br /> �j i <br /> —.� • <br /> �� ���: V{�'r��� �����.rCl����'� <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 Lisf of Fixfures #°f List of Fixfures #of List of Fixtures <br /> Fixtures Fixt Fi�ctures Fixfures <br /> A/C-Air Handling U j at P 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 /> Number of Heads <br /> ACKNOW/_EDGEMENT:I have reviewed fhis application and confirm the information contained herein rs true and correct. Work done pursuant to this permif must comply with <br /> current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing fiom the <br /> euilding Official before being authorized under any circumstance.I am tiie owne�or l am authorized by the owner of this property to pertorm the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Evereft Official Use Only <br /> �� .� � ��� PERMIT <br /> ,: I� � J� <br /> ,t��- � �� y-�-o� <br /> OwnerlAuthorized Agent Signature Date (Revised 5/20/2 96) ] <br /> i I-} <br /> ! <br /> ,``_ <br />