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� F�ERMIT APPLICAT!° • <br /> BUfLQ �.HANICAL / PLUMBING /SIG: �KLER / DEMOLfTION <br /> CITY OF EVERETT PERMIT SERi,�i.._ <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 /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: j '� � PROPERTY TAX#: ," � <br /> L( / . � !�� L. �C=' / ''���% ;S<� <br /> LEGAL for new construction: Short P�avsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �- � d Z���1-` /� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srkEEr � C 7 ''� � 1� <br /> ��n '� :� , - S STATE � �r Z�� �1�C"�F <br /> OWNER PHONE: � — ,- '�'— `/,�5' OWNER EMAIL: <br /> CONTRACTOR NAME: � ! � <br /> CONTRACTOR ADDRESS: sTReeT <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAfL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERE7T BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR �OTHER(Please Specify) � ,� ��i� "/ f ^ <br /> CO TACT NAME: CONTACT PHONE: ;� - `7��..,— � 7� ' <br /> 1/�� C �C'C7�I i,`L GONTACT EMAIL: 'G t'(�f--: ��'�i�: !j �� �-i G i'_• �`7 <br /> BUILDING PERMIT APPLICATION <br /> Existin Use of Buildin : Contract Price of Work:$ <br /> Proposed Use of Buildin : Heat Source: ❑Gas ❑Electric ❑Other <br /> Buildin T e: ❑SFR-Detached ❑SFR-Attached �Duplex ❑Multi-Famil -#of Units: OCommercial �Industrial <br /> T pe of Pro ect: ❑New ❑Addition ❑Remodel ❑Repair ❑T 1. ❑Si n ❑Sprinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: <br /> , <br /> . <br /> l��(t`" �(��C�-�l� � !'��Jc(��-� E�" �����"'i�-� ��� ��r�c���( � -_ ,'(�C vz`'li ,�,C((���r1'I <br /> J <br /> . � , <br /> A5'SOCIATED BUILDING PERMIT#(if applicable) <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn _Aiteration Repair Type of Project: New _Addn Alteration Repair <br /> #of List of Fixtures #of List of Fixtures #°f List of Fixtures #of List of Fixtures <br /> Fixfures Fixtures Fixtuves Fixtures <br /> A/C—Air Handlin Units Heat Pump Toilet Backflow Preventer(Inside Bld ) <br /> Forced Air S stems Unit Heater Bathtub Urinal <br /> Gas Pipin Boiler ' Lavato (Wash Basin) Drinkin Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ductin Dishwasher Roof Drains <br /> Clothes D er Hooku s Other: Clothes Washer Medicai 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:l have�eviewed this application and confrrm the iitformation contained herein rs true and correct. Work done pursuant to this permit must comply with <br /> current lederal,state.and local law. The granting of a permit only aufhorizes approved work and no deviations therefrom.Deviations must first be autho�ized in writing from the <br /> Building Officiai beiore being authonzed under any circumstance.I am the owner,or I 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 OKicial Use Only <br /> �-- PFRMIT# <br /> �-�� �-���� �.��jci�<-�,���� � � ' � <br /> wner/Autho � Agent Signature � f�:te `-'evisr�:l 10i7�'-'201:>) � <br /> � Z <br />