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� PERMIT APPLICATI� <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: ��'J�"� ��t� 7�}'U-� S� t"V41'�' PROPERTY TAX#: �'7%.�4'���C-'�r.��G'v,�- <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description � �l� �� �� <br /> CONTACT INFORMATION <br /> OWNER NAME: p�°`� /��'j i/?�'I�'J � � TENANT NAME(If Commercial):S�%�C��' ��A►� t '� �CtiG>�(' <br /> OWNER MAILING ADDRESS: srREET �- �Q� 'L2j('J� j ��/ '��/j--{'!� rl,�.;`y;;��.._: <br /> crrv _ I7�c�✓I f�. d�, � srnrE �/� ziP �8 v� <br /> OWNER PHONE: �L�'/�j. ���"cj �''� OWNER EMAIL: AL ��' S�rI C� ��(�vj SC�(;it' � .�'C�4�✓J <br /> CONTRACTOR NAME; �-�r� � " �-��`t�j/t����f-- �/VE-'��--� �' <br /> CONTRACTOR ADDRESS: sTReer ��1� - f GI �lj SG� <br /> CI7Y ��(/ �G'�Q STATE ZIP <br /> CONTRACTOR PHONE: '�{��`-2/ �'— �j CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR OTHER(Please Specify) ��G'-til �'f � <br /> CONTACT NAME: ��� �.�n�� CONTACT PHONE: �G� `�Gf-,�r'._ S�� � <br /> L�>9-7C lf /�S/�-N S"�L+O/G'. (�LG CONTACT EMAIL: �/�'.� � L'��1�0/_>f 7/J I G CC%v'� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ���' {^�'ii��11 , Contract Price of Work: $ - �, C%GC <br /> Proposed Use of Building: � v(C�`f��'� Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: �ommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: � � � �Ujr C4��r�i ��il/��� V"��''��� L`�`�S vvc� �YLr�- <br /> ��Yt; /�/L�- � <br /> cd�..�� � ��� �fo � �c�(i,��f�e,�,�'' <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 #�f List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixfures 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& 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 /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the in(ormation contained herein is true and correct. Work done pursuant to this permit must comply with <br /> current federal,state,and local law. The granting of a permit only auihorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.1 am the owner,or 1 am authorized by the owner of this property to perform 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 Everett Official Use Only <br /> /���% j�' n ` PERMIT# � � <br /> / ��� ���G ��-� (�i �c��-�73 <br /> Own -Authorized Agent Signature Date (Revised 5/20/2016) <br />