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PERMIT APPLICATI�'I <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 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> (Blue orBlack Ink On1y;Please)' PRAJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ��d I .�",S 'OC��,`K,��l ��D PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): ��,e(,�Yti t MiV`�'� <br /> OWNER MAILING ADDRESS: srReET <br /> CIT' " STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME; u,S � � {�wj _ � <br /> CONTRACTOR ADDRESS: s-raee-r Q �� <br /> cirr � STATE W ziP ���j <br /> CONTRACTORPHONE: �b�'� p S'�-`� CONTRACTOREMAIL: �` �y� j� j� '�vv� <br /> CONTRACTOR LICENSE#(REQUIRED): �,�(,��� �Z.L CITY OF EVERETT BUSINE L ENSE#(REQUIRED): �S �ei l Z�'I <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 3 b�-��6�'S S <br /> G �L �Cy Q�✓�� CONTACT EMAIL: �' ��I i �C. ��l�I <br /> BUILDING PERMIT APPLIC TI <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 ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: � � <br /> �2(� ni��e.+n �wS (,�t,�`�� i�t�i� u`^Z " c.�, ��v�,� <br /> � .J <br /> i 2U� Ox��,�► r��n,s ��f� �o^� v�� �w` � <br /> ASSOCIATED BUILDING PERMIT#(if a licable : <br /> MECHANICAL PERMIT APPLICATION PWMBING PERMIT APPLICATION <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: _New _Addn _Aiteration _Repair <br /> #of List of Fixtures #�f List of Fixtures #�f List of Fixtures #of Lisf of Fixtures <br /> Fixfures Fixtures Fixtures Fi�ctures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bidg) <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 /> Ciothes Dryer Hookups Other. Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other. <br /> SPRINKLER7 SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•1 have reviewed this application and confirm the information contained herein is true and correcf.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 O�cia/before being authorized under any circumstance.I am the owner,or l am authorized 6y the owner of this property to perform the work for which application is made, <br /> and l comply with the State Confracfors Law 18.27 RCW and 296.200A WAC <br /> City of Everett Official Use Only <br /> .- PE MIT# <br /> Z� % � - O <br /> O r/ or' eil Agent Signature ` Date (Revised 9/23/2016 <br />