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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 j FAX 425-257-8857 1 (E) eve retteps everettwa.gov j www,everattwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITS INFORMATION <br />PROJECT SITE ADDRESS: t C t —/" " ` pl. W <br />LEGAL for new construction: Short PlaUsutxiivis€on PROPERTY TAX #: <br />No.' (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: -Ci t� TENANT NAME (if Conlmerciati- <br />OWNER MAILING ADDRESS: STREET <br />CITY <br />R PHONE: <br />CONTRACTOR NAME Ek ` <br />CONTRACTOR ADDRESS: STREET `( <br />CITY G <br />CONTRACTOR PHONE: L 7jq <br />CONTRACTOR LIGENSE #(REOtllRED)CAIY <br />- <br />PRIMARY CONTACT: ❑ OWNER CC? <br />CONTACT NAME: ejob a' <br />0 �?01n l -7 `M <br />nc <br />OWNER EMAIL: <br />STATE Lkj ram" ZIP <br />STATE W f i- ._.._... ZIP q g-Zn I <br />CONTRACTOR EMAIL Cc <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): _ D 0 <br />❑ OTHER (Please Specify) <br />CONTACT PHONE: 2S j O5C <br />CONTACT EMAIL: &�Lb (Q <br />BUILDING PERMIT APPLICATION ` <br />.E\isting Use of Buildin Contract Price of Work: $ ,-- <br />Proposed Use of Building: <br />at Source: as ❑Electric ❑Other <br />Building Type: FIR -Detached ❑SFR-Attached ❑Duplex []Multi- Famll #k of Units <br />_ ❑Commercial <br />Type of Project, ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. <br />gESCRlION OF WORK: QSir�n C7Sprinkler ❑Demolition ❑Chan, <br />PT^n � <br />ti[.W VINJ <br />[ASSOCIATED BUILDING PERMIT # (If applicable): <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New — Addn _Alteration _Repair <br />kof #of <br />—Air Handling Un <br />:ed Air Svstems <br />Cl <br />Boiler <br />❑lndustrlal <br />of Use <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn Alteration _Repair <br /># or tt or <br />— _List of-Fixturea <br />rturas Fixtures moist of Fixtures -- <br />Toilet Backflow Preventer Inside Bldg; <br />Bathtub Urinal <br />hover <br />ltchen Sint <br />ishwasher <br />Floor D <br />Grease <br />Fountain <br />___ uaurvw�Nrstc. Uther: <br />SPRINKLER I -SUPPRESSION SYSTEM <br />Chemical or Water - -- <br />No. of Heads <br />ACKNOWLEDGEMENT.. 1 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. Devintions must first be aufhoo7.nd 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 which application is made, <br />and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use pr 1y <br />PE # <br />-- <br />Uw erlAuthorlZed Aga 3tgnaturca <br />/'� Dale (Revised 9l23(20t6) <br />