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� P�RIlIIIT APPLICA710fV� <br /> BUILDIi�IG / i�ECFi/�RIICAL/ PLUMBING /S1GN /S6'RIIVKLER/ DEi�iOLIT'ION <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 Black Ink Only @lease) PROJEC'I'SITE INFORMATION <br /> PROJECT SITE ADDRESS: `�j�' ����- L�.���- " PROPERTY TAX#: <br /> � <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �' � TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReer j p�Zl>O �,/���<�Pr',�ti i.✓�� cA <br /> ` <br /> CITY STATE Z�P <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME; - � � 2cy /' > <br /> CONTRACTOR ADDRESS: sTReeT '- �j s- ��. �vc> - <br /> ,� � <br /> CITY -��� , STATE Z�P <br /> CONTRACTOR PHONE: 1�� ` ' � -(j CONTRACTOR EMAIL: ;�,. �1 ���-ti,�_ ��-, � -�ti , ;. �pyt <br /> CONTRACTOR LICENSE#(REQUIRED): _� •� (-'�l�I( -!- I C�L��l � CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): �.'(���;' ! <br /> _.... .._.. . ......_ . , _.,... . ..... . <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: c/'��— j j� � ��� <br /> � <br /> � <br /> � �';,,^ - ����, CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ � � Y�� �� <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 � emolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> � J <br /> >.L,2��� �-��L c ��c�y� i`� � ct� <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 Fi�rfures #°f List of Fi�cfures �°f List of Fixtures <br /> Fixfures Fiactures 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: Ciothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> �PRSIdFSI�L��t/ ��PPRL���IAI�! �XS7'�M <br /> Number of Heads <br /> ACKNOWLEDGEMENT:l have reviewed this application and confirm the information contained herein is frue and correcf.Work done pursuant to fhis permit must comply wrth <br /> current federal,sfate,and local law. The grantrng of a permit only authorizes approved work and no deviations therefrom.Deviatrons must first be authorized in writing from the <br /> t3uilding Official before being authorized under any circumsfance.1 am the owner,or I am authorized by the owner of fhrs proper(y to perform the work for which application is made, <br /> and 1 omply wifh the State Contractors Law 98.27 RCW and 296.200A WFlC. <br /> � Cify of Everett Official Use Only <br /> PERMIT# <br /> _ �- '" - �-� :� f � _ �.��� <br /> wn r/Authon gent Sign ur / Date (Revised 5/20/2016) <br /> , i � � <br />