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PERMIT APPLICATION
<br /> BUILDING/MECHANICAL/PLUMBING 1 SIGN /SPRINKLER/DEMOUTION
<br /> CETY OF EVERE77 PERMIT SERVICES �
<br /> 3200 CEDAR STREET,EVERETT,WA 98201 �
<br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everetfwa.gov� www.everettwa.govlpermits �
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<br /> � - ,� -> P-.ROJECT SITE;INFORMATION . ` ` ; !
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<br /> PROJEC7 S1TE A DRESS: � PROPERTY TAX#: !
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<br /> LEGAL for new construction: Sfiort Plat/subdivision Lot Mo. (atEach copy of long legal description) �
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<br /> t 3` `' ' .,:�CONITACTINFORMATION; ` , '
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<br /> OWNER NAME: �V e \ TENANT NAME(If Commercial): �
<br /> OWRIER MAILWG ADDRESS: sTaeer p �'�S-� S � �
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<br /> fJWNER PHON o(, 1 (� OWNER EMAIL:
<br /> CONTRACTORNAME: �aSCu e C� tS "o .t +
<br /> CONTRACTOR ADDRESS; STREET O �-`r �/�' ti� �
<br /> CITY � �!/ STATE ZIP 7� �
<br /> CONTRACTOR PHONE: 5 �j- / 6 CONTRACTOR EMAIL: p�ta t? �, �,c� � 1 o�tJ • CE.•-� �
<br /> CONTRACTOR LICENSE#(REQUIRED): �Q� ClTY OF EVERE77 BUSINESS LICENSE#(REQUIRED) � , �
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<br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑07HER(Please Specify} �
<br /> CON7ACT NAME: CONTACT PHONE: �. '�S'G,� —"7�6
<br /> �j�, H � C ��.L CONTACT EMAIL: C � L{ C /l eJ « CE'� `
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<br /> " '���'�� r � BU��.D�NG-PERMIT,AP�I.ICATION p
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<br /> Exisfing Use of Buiiding: Contract Price of Work:$ � ;
<br /> Proposed Use of Building: Heaf Source: ❑Gas Y�Elecfric ❑Other �
<br /> Building Type: �SFR-Detached ❑SFR-Aftached ❑Dupiex C1Multi-Famil �#of Units: ❑Commercial ❑Industrial �
<br /> T e of Pro'ect: ❑New CiAddition ❑Rema el �flRe air ❑T.I. ❑Si n ❑S rinkler fk�Demolit+on ❑Chan e of Use �
<br /> DESCRIP710NOFWORK: �. @�0`itr E�@ << ivts�l�a��`O�t� ��r�kl� ��o "t..ye P1,��,� �
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<br /> ASSOCIATED BUILDING PERMIT#(if applicablej:
<br /> .�MECI��lN1CAL PERMIT;A,PPLICATION :,,,�, ;_: ;;.'„ „ „�;;PLUMBlNG�„PERMIT APPLICATION,_� ;� �
<br /> Type of Pra�ect: _New`_ Addn Alteration �f2epair e of Pro�ecE: �New Addn Alteration Repair �
<br /> #of #of #of #of �
<br /> List of Fixfures Lisf of Fixtures of Fixfures �xtures ;
<br /> Fixtures Fixtures Fixtures Fixtures �
<br /> A/C—Air Handling Units Heat Pump � Toilet ow Preventer(Inside Bidg) �
<br /> Forced Air Systems Unit Heater Bathtub Urinal
<br /> Gas Piping Boi[er Lavatory(Wash Bas� Drinking Founfain s
<br /> Water Heater Refrigeration � Shower Floor Drain �
<br /> Gas Fireplace - Woad Stove � Kitchen Sin posal Grease Trap =
<br /> Gas Range Ducting Dishw aof Drains �
<br /> - Clothes Dryer Hooku Other: C s Washer ' al Gas -
<br /> Range Hood ater Heater Othe. �
<br /> � Exhaust�an Sink(Service/BartMople . ther.
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<br /> � __`;SPRINKLER/_SUPPRESSION SY�i'€M::�., �:_:
<br /> Number of Heads
<br /> ACKNOWLEDGEMENT.•I have reviewed this application and confirm the information contained herein is troe and correct Work done pursuant to this permif must comply with
<br /> current faderal,state,and locallaw.The granting of a permif onty authorizes approved work and no deviatlons fheref�om.Deviations must first be authorized in writing from the
<br /> Building O�cial before being authorized under any circumsfance.!am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made,
<br /> and 1 comply with fhe Sfate Contracfors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Officia!Use Only
<br /> / PERMIT# 1
<br /> ,�%�c1,�.t.t,w. 17 E,u��wi1 ry�Z �D^�V ' �� v" '�� _
<br /> OwneriAuthorized Agent Signature Date (Revised 10/�y20�5) r
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