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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(i�everettwa.gov� www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: �{SO Co ^J t�l�� ��/L C PROPERTY TAX#: �� 'L ��t <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: S 6 1�v�no•n � <br /> (,�, r fi � �.� ,��;L 1 TENANT NAME(If Commercial):. �� ������y✓� �L. <br /> OWNER MAILING ADDRESS: srneer `�t'()�,a ��r�'' Sfi S�� <br /> cm �Vh����� STATE �� zia �cR-(_�• <br /> OWNER PHONE: ZC7�i - ��'1 S — ��-I�t�' OWNER EMAIL: AI�E�C�S��-'G M�,N S�-'CtC�OL�C.L� <br /> CONTRACTOR NAME: �� ��5 ' G�(il(1_'�Gl.� C' �1� cJ 1l � <br /> CONTRACTOR ADDRESS: srneeT � � � � <br /> cm L �'1 wUC� STATE ,1�, zia � � <br /> CONTRACTOR PHONE: LLC�' -7r�(a `5��� CONTRACTOR EMAIL: �V1G�,'�`"r. ��C�I C�ej . YYICI�I CG��Y1 <br /> CONTRACTOR LICENSE#(REQUIRED): �;(J H`�(�, ���j CITY OF EVERETT BUSINESS LICENSE�!(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR OTHER(Please Specify) (. � iC v� S \Q <br /> CONTACT NAME: CONTACT PHONE: 2(� ���.,�— �j�j <br /> �I�i��� ��l C:t.r"�✓�O. CONTACT EMAIL: C�iC.E'. ` �C'��-U�511..(�+G.C O��1/� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: s � r�?j � ;,�h� ����<y�C�M Contract Price of Work:E �� � �J�� <br /> Proposed Use of Building: � v��rfi��f\ ��Cu, �'��i, ���CI�SS\� eat Source: as ❑Electric ❑Other ' - <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Dup ex ❑Multi-Family-#of Units: ommercial ❑Industrial <br /> T e of Pro'ect: ❑New ❑Addition emodel ❑Re air ❑T.I. ❑Si n ❑S rinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: <br /> ��r,t,�� � 5-�''`'] ����r;�� ���(���vly , -�evn�r� -��uh�� �.,�,1(S c�.v� �fi��S l�S. ��y <br /> Vtu�.� w�l cx v��J �'�v��S k�5� �� �����c�S, <br /> ASSOCIATED BUILDING PERMIT# if a licable: Q� �t V1 i �Gt�( �I�i'�M l✓I�' i.�((� �-�-�-�' '7r'Yl��,k-' �`�'���� � � C i'v���'�� Y" <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn Alteratfon _Repair Type of Project: _New _Addn Alteratlon _Repafr <br /> #of �st of F/xtures #of List of Flxtures #of �/st of Fixtures #of Llst of Fbrfures <br /> Fixtures Fixtures Flxtures F/xtures <br /> A/C—Air Handlin Units Heat Pump Toilet Backflow Preventer Inside Bld <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Pi in Boiler Lavato Wash Basin) Drinkin Fountain <br /> Water Heater Refri eration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Tra <br /> Gas Ran e Ductin Dishwasher Roof Drains <br /> Clothes D er Hookups Other: Clothes Washer Medical Gas <br /> Ran e 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 information contained herein is due and conecf.Work done pursuant to this pertnit must compty 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 wrifing from the <br /> Building O�cial befo�being authorized under any circumsfance.I am the owner,o�1 am authonzed 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 /> Cify of Everett Official Use On/y <br /> PERMIT# <br /> G^'i/ ����1 (-;� <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />