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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 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits
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<br /> PROJECT SITE ADDRESS: ZJ I a �t�SI �. � R��� PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
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<br /> OWNER NAME: TENANT NAME(If Commercial): a ' GS��, l o V 2
<br /> OWNER MAILING ADDRESS: srReeT
<br /> � CITY STATE � ZIP
<br /> OWNER PHONE: OWNER EMAIL:
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<br /> CONTRACTOR NAME; �r'4"In WR.S� 4/�� I�A S S��`'� �
<br /> CONTRACTOR ADDRESS: sTReer �t�a ,j'"..i ?�h
<br /> CITY C.D� STATE W�� ZIP C�J �
<br /> CONTRACTOR PHONE: yZ-J� �I bv .�•'L'L F$ CONTRACTOR EMAIL: �J F�'�C.�► � NW t"�S • <f�M
<br /> CONTRACTOR LICENSE#(REQUIRED): f�IO R(hj W (j 2�7'�S� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):C'�I S�
<br /> PRIMARY CONTACT: �OWNER (�ONTRACTOR O OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: �.-?(�� ��„�'j_,
<br /> �G /�-�-5 Fl ��-�^ CONTACT EMAIL: ,, F� ''^�,L. C,j /UW � f' . �Nt
<br /> '' BU1I�DING�PERM;IT AP3PLICQ'FIOFi -_
<br /> Existing Use of Building: t�-1 e.rtG� a�s e Contract Price of Work:$ �� � ��"�
<br /> Proposed Use of Building: ��� �d�S Q Heat Source: ❑Gas ❑Electric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Famil -#of Units: �ommercial ❑Industrial
<br /> Type of Project: ❑New [�ddition ❑Remodel ❑Repair �T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
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<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
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<br /> Type of Project: New Addn _Alteration Repair Type of Project: New Addn Alteration Repair
<br /> #°f List of Fixtures #�f List of Fixtures #of List of Fixtures #°f List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bid
<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/Mopletc.) Other:
<br /> SPRINKLER,/S�PPRESS.lON SYSTEM'
<br /> Chemical or Water No.of Heads
<br /> ACKNOWLEDGEMENT:I have reviewed this application and con�rm the information contained herein is true and correct.Work done pursuant to this permit must comply with
<br /> current federal,state,and local iaw.The granting of a permit only authorizes approved work and no deviafions therefrom.Deviations must first be authorized in writing from the
<br /> Building Official before being authorized under any circumstance.I am the owner,o�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 Contracfors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT# �
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<br /> Ow er uthorized A nt Signature Date (Revised 9/23/2016)
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