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� PER�11T APPLICATIORI• <br /> �191LD0YVC� / IVdEGt-E�►IdlC,4L/ PLUIV��Ih�C� /SIGR! / SPR9NC�LER/ D�NIOLITION <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 /> (�lue or �Back Ink Oney �lease) P120JEC'T SITE INF01�lVIAT90P� <br /> PROJECT SITE ADDRESS: S�/G1 �7`�77/'.�/�/ �v3G!^� C��j PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> COtV7'ACT I�IFOl2MATIOnL <br /> OWNER NAME: v�j�vJ ��r f` �,t,t N TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREEr � �G� / ,/>I�• �✓ <br /> � <br /> CITY �(/iG-�Y�L� � STATE ZIP �� <br /> OWNER PHONE: 7 . �f 7'. �l2-� OWNER EMAIL: <br /> CONTRACTOR NAME: �y� �� L(,' �(,} l��i�lUv� `�c�/ S t!�c c�✓! �LCi <br /> CONTRACTOR ADDRESS: srReEr � - � <br /> �/"' �,��/C v Z�- f <br /> CITY //�� STATE (/l/� ZIP (J Z��J� <br /> CONTRACTOR PHONE: � L`�j - � ,. ��P�i � CONTRACTOR EMAIL: G�r� G G'G�C>��/jG .li f C"�J.,c,S'�l.tC�.Ld„(il <br /> CONTRACTOR LICENSE#(REQUIRED): p �rr��3;' z CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):� "� <br /> PRIMARY CONTACT: ❑OWNER F�I CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: !���. `t�Lf , ��� <br /> !'i�v�Gl/� C.l�-L�b� CONTACT EMAIL: �ru;,� � V.���G�• ' e�, <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ '��J <br /> Proposed Use of B�ilding: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: C'.�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 WOR : � <br /> �j ��c5 s G�� c�-�G� � / `7�v�e S�i l4'� -��-��, � � <br /> s'� ����-� ��-y�-,�-�'�%�,� �� �.c -�-�-a--�' . <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMiT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration Re r Type of Project: _New _Addn _Alteration _Repair <br /> #of Lisi of Fixtures #�f sf of Fixtures #of Lisf of Fi�ctures �°f List of Fi res <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Pr enter(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Dri ng Fountain <br /> Water Heater Refrigeration Shower oor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes er Hookups Other: Clothes Washer Medical Gas <br /> Ran ood Water Heater Other: <br /> E aust Fan Sink(Servic ar/Mop/etc.) Other: <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Chemical or Water No. of Heads <br /> ACKNOWLEDGEMENT:1 have reviewed this application and confirm the informa�on contained herein is true and correct. Work done pursuant to fhis permit 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 autlionzed in writing from the <br /> Building Official before jng authorized under any circumstance.l am the owner,or I am authorized by the owner of this properfy to perform the work for which applicatron is made, <br /> and I comply ith th Stat�Contractors Law 18.27 RCW and 296.200A WAC. <br /> , City of Everett Official Use Only <br /> �_ PERMIT# <br /> � 7-�� � � i 7� �, '` ��� <br /> OwnerlAut orized Agent Signature Date (Revised 9/23/2016) <br /> � <br />