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<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� wvwv.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: � r � �:,� �M ' � �� PROPERTY TAX#: L. � � � .X�;; ��,�e. � j
<br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: � � � - j�; 7�- �NANT NAME(If Commercial):
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<br /> OWNER MAILING ADDRESS: sTREEr /
<br /> CIIY � , / �1� STATE ��� ZIP
<br /> OWNER PHONE: � � � �j� � - � OWNER EMAIL: L�1;C -:t '�(�;';�.�r�, � . � ��rU' � . �,,• �
<br /> CONTRACTORNAME; � ' (,7 ?"�,�,r�, l ;2� (�+'Z, � ;� �'l �.����
<br /> CONTRACTOR ADDRESS: srREEr � � , �, ;
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<br /> CONTRACTOR PHONE: v� � j ' j l ? CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): ��,- ��' �, - / ` i.��,��i:- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): V ���?
<br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: %. � CONTACT PHONE: � ji� , ..�J '�' �i(; �'+ ( �(
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<br /> ,� CONTACT EMAIL: �' �� (�v i,: U11�j,,�� � ';�7�
<br /> BUILDING PERMIT APPLICATION'
<br /> Existing Use of Building: �--q � =�r,iL-, Contract Price of Work:$ � � I ��b
<br /> � a;,
<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 f'�� � , L,r�; -���� �;� ,��,�.�-il;'
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<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 Fiutures #�f List of Fixtures #°f List of Fixtures �°f List of Fixtures
<br /> Fixtures Fi�ctures Fixtures Fixfures
<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 r' 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 /> SPRINKLEEt/ SUPPRESSION SYST�M
<br /> Number of Heads
<br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained he�ein is true and correct. Work done pursuant to this permit must comply with
<br /> current federal,state,and local lav✓. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in wrifrng from the
<br /> Building Official before being authorized under any circumstance.I am the owner,or I am aufhorized by the owner of this property fo perform the work for v✓hich applicafion is made,
<br /> and I comply witli the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Offrcial Use Only
<br /> 8 � PERMIT#
<br /> � �~���^ [ �' '� ,'a � � �� ' ��
<br /> OwnerlAuthorized Agent Signature Date (Revised 5/20/2016)
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