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PERMIT APPLICATIOI� <br /> BUILDING /MECHANICAL i PLUM�IIVG /SIGIV /SPRIRIKLER/ 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@eve�ettwa.gov� www.everettwa.gov/permits <br /> (Blsee or Black lnk Only Plea�e) PROJECT SITE If+IFORME1T10N <br /> PROJECT SITE ADDRESS: �� I� �"���~ S� SW ��er'�.�r a,O3 PROPERTY TAX#: S7 D y1 D <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Sp �v .� qAv� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s-rReer ��I ( �� �'�— S�✓ <br /> CITY �e r e�'!"' STATE � ZIP ��} <br /> OWNER PHONE: 3+�O ` 'a,�d -� �.�� OWNER EMAIL: q� '� p (r� �A M , C,v+�n <br /> CONTRACTORNAME; �p,M„Q bv�ln�er <br /> CONTRACTOR ADDRESS: sTReeT �t.� l�( � �'�� S� <br /> CITY ��,/�r�}"' � STATE ZIP <br /> CONTRACTOR PHONE: ,3(�O ' � pC�'"��� CONTRACTOR EMAIL: ��r,, �I^ (1,d'�r1^o��� .GQ <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> _ . <br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �j� — �f�(� • a`�S <br /> �p 5�✓ � Si.� CONTACT EMAIL: ,s �:,�'VS(�@ M„q(� . t�r^ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ��en,'�.� Contract Price of Work:$ ��C� � �c9 Ml4lt��nrV�.✓" <br /> Proposed Use of Building: ;q�v�.`�.�, Heat Source: as ❑Electric ❑Other <br /> Building Type: R-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commerciai ❑Industriai <br /> Type of Project: ❑New �Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: � ��1 R,��la��w.�,�'!"', �qG)�� d� ���e. <br /> �,_. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> �°f List of Fixtures #�f Lisf of Fixtures #of List of Fixfures #°f Lisf of Fixtures <br /> Fixtures Fi�ctures Fi�cfures Finfures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer{Inside Bldg) <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 1Nood 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/Mop/etc.) Other: <br /> SPRINKLER/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 correct.Work done pursuant to this permif 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 Official before being authorized unde�any circumstance.I am the owner,or i am authorized by the owner of this properry to perform the work for which application is made, <br /> and 1 comply ith the State Contr cter,�Caw 18.27 RCW and 296.200A WAC. <br /> City of Everett O�cial Use Only <br /> S � ( � PERMIT# ��0�` �y�� <br /> U <br /> Owner/A t riz gent Signature Date (Revised 9/23/2016) <br /> � <br />