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• PERMIT APPLICATION� <br /> �UILDING / 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� wv�nv.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: �j 30� /�L �, ��� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:�✓�/f �OY �I� � �G C- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReEr �d �Q�/0 h 4(� �C <br /> CITY ��(f e(/C� STATE V V�7 ZIP Q/ <br /> OWNER PHONE: Z d6 " �� 9 � SUS � OWNER EMAIL: <br /> CONTRACTOR NAME: Vv�G 1 /L �Q,�j ��l � ) � I NC— <br /> CONTRACTOR ADDRESS: srReer �j (' �. N u� � S <br /> CITY �C,'J(r"f/�� STATE � ZIP b �D / <br /> CONTRACTOR PHONE: �7 Z 5� 3 Z S ' S /O CONTRACTOR EMAIL: �r�'(,I�p dJ�^L°G,I � d � <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER L�CONTRACTOR ❑OTHER(Please Specify) <br /> CONTAC�AME: CONTACT PHONE:�I ZC- 3x�� C�-� � <br /> �� � ��/��/� CONTACT EMAIL: � ��S�W��O�/ ��� � <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑D lex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel epair ❑T.I. ❑Sign ❑Sprinkler emolition ❑Change of Use <br /> DESC�TION OF WORK: � � � <br /> %c�'f'� C,�`21�t�(� �'r c,`�, a �' �!�( 5�"�� ��� �r-c/ �4c� <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 Fi�rfures ��f List of Fixiures #�f List of Fi�ctures #°f List of Fixtures <br /> Fixfures Fixtures Fixfures 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: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No. of Heads <br /> ACKNOWLEDGEMENT.I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this 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 authorized in writing from the <br /> Building Official before being authorized under any circumstance. I am the owner,or I am authorized by the owner of this property to perform the work for whrch application is made, <br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ���n����li / � L� / PERMIT�� I V � —/\O � <br /> i K/ �� CJ <br /> Owner/Authorized Agent Signature Date � (Revised 9/23/2016) <br /> � � <br /> r <br />