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PERMIT APPLICATION <br /> BUI�DING/MECHANICAL/PLUMBING i SIGN/SPRINKLER/DEM4LITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREE7,EVERETT,WA 98201 <br /> (Pj 425-257-8810 � FAX 425-257-8857 ((Ej everetteps@everettwa.gov( www.everettwa.gov/permits <br /> (Blue or Black lnk Only Please PROJECT$ITE INFORMATION <br /> PROJECT SITE ADDRESS:�(�1 (r'J `�I�O�D V��� �'j��G%�CT �I go�d I PROPERTY TAX#: �� () � <br /> LEGAL for new eons#ruction: Short PlaUsubdivision Lot No. (attach copy of long legal description} <br /> CONTACT INFORMATION <br /> OWNER NAME: �IL1V�. }��)l�fss w�'i TENANT NAME(If Commercial):(���✓�iy�$ �VI��(9�1.� <br /> OWNER MAILtNG ADDRESS: STREET 7j�I� pY•-(/�VVV y�- - `�j <br /> CITY �� STATE ��" ZIP � p��j ( <br /> OWNER PHONE:a - OWNER EMAIL: �A,-('1C�-► � C�"� �1 <br /> CONTRACTOR NAME; M y(,(6-^f I(�C�i � �I�I �•. FS�3' <br /> CONTRACTOR ADDRESS: sra�er 'a�(�� �(�( <br /> cm /���1��'"�Q(� srAre �� z�P ���v�� <br /> CONTRACTOR PHONE: �j(f,��-� �9` � CONTRACTOR EMAIL: Wt t C�IC@ SI1a��[I V�.S) Vl. Gf�YV� <br /> CONTRACTOR LICENSE#(REQUIRED): ���SPti� ��� CITY OF EVERETT BUSINE3S UCENSE#(REQUIRED):��U�I <br /> PRIMARY CONTACT: ❑OWNER �'CONTRACTOR ❑OTHER(Piease Specify) <br /> CONTACT NAME: CONTACT PHONE: 3(�Q_L��j�> <br /> M� � �c���S CONTACT EMAIL:�y►t��S�Ye.�i Vte$� �/1 l�Tj V1/1 <br /> BUILDIN6 PERMIT APPLICATION <br /> F�cistin Use of Buildin : Contract Price of Work:$ <br /> Pro sed Use of Buildin : Heat Source: ❑Gas ❑Electric ❑Other <br /> Buildin T e: ❑SFR-Detached ❑SFR-Attached ❑Du lex OMu{ti-Famil -#of Units: C7Commercial ❑Industrial <br /> T e of Pro ect: ❑New �Addition ❑Remodel ❑Re air �T.I. i n ❑S rinkler ODemolition ❑Chan e of Use • <br /> DESCRIPTION OF WORK: <br /> t rts�c.A-u- c�.-�y C�)�'-►o"x ��_��� po vt�►�-�a�c� t��v�m i ntA-r� c��r N�-r ntsP�-y: <br /> ��U��C6r1Cy M D V�N'f vN GDfRN�1�- 6� �3 i.t,t f,p�N 6-w11'fkk S'f���P-.ft GiG�'t 5 k. DECO f�'(t✓� S-H'Ro t�I�OS- <br /> ASSOCIATED BUILDING PERMIT# if a licable: <br /> MECHANICAI.PERMIT APPL,ICATION PLUMBIN6 PERMIT APPLICATION <br /> Type of ProJect: New Addn Aiteration _Repair Type of Project: .,,�,New ^Addn _Aiteration `Repair <br /> #of ��y�of Fixtures #of List of�xtures #of Ltsf of Flxtures #of tlst of Fixtures <br /> Ffxtures Fi�ures Fixtures Fixtures <br /> A/C-Air Handlin Units Heat Pum Toilet Backflow Preventer Inside Bld <br /> Forced Rir S stems Unit Heater Bathtub Urinal <br /> Gas Piping Boilsr Lavatory(Wash Basin Drinkin Fountain <br /> Water Heater Refti eration Shower Floor Drain <br /> Gas Firepface Wood Stove Kiichen Sink&Disposai Grease Trap <br /> Gas Ran e Ductin Dishwasher Roof Drains <br /> Clofhes D er Hookups Other: Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink ServicelBar/Mo letc. Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•f have rev/ewed thls appticat/on a»d confirm the lnformation contalned hereln Is true and correck Work dona pursuant fo thls permk must compiy with <br /> cuRent federal,state,and loca!law.The granting of a permlt onty authorizes approved work and no devlations therefrom.Deviations must first be authorized/n writing from the <br /> Building Ofi/clai befons being authortzed under any clrcumstance.I am the owner,ar I am authorized by the owner of thls property to perlorm the work for whkh applicat/on!s made, <br /> and!compiy wlth the Stafe Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use On/y <br /> PERMIT# <br /> � � ab I � �S I o�--� I <br /> OwneNAul iorized Agent Signature Date (Revised 9/23/2016) �� <br /> � <br />