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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: �`Z.��j S(��� �s7 �S 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: �(�., ���d�i�l TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: srReer 'L(7 �� �� ((�
<br /> CITY � STATE � ZIP ����
<br /> OWNER PHONE: �'LS• I�J' � •(,Q�,Qip� OWNER EMAIL:
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<br /> CONTRACTOR NAME; �, � o ^UYLS
<br /> CONTRACTOR ADDRESS: srReeT 7 (' ��g
<br /> CITY � �J�� STATE a ZIP U�J�V
<br /> CONTRACTOR PHONE: 3�QO•�QSQ •�� CONTRACTOR EMAIL: � y� � yL � L�
<br /> CONTRACTOR LICENSE#(REQUIRED):r �C�P���l�t.���Z� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): �� �$
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<br /> PRIMARY CONTACT: ❑OWNER I�'CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 3t�b, tC�S� '[��j�
<br /> V'�-v��V�- �J-.JF�1��� CONTACT EMAIL: '�r � � � �
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<br /> Existing Use of Building: Contract Price of Work:$ j�6d
<br /> Proposed Use of Building: Heat Source: as ❑Electric ❑Other
<br /> Building Type: �SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial
<br /> Type of Project: ❑New ❑Addition ❑Remodel �2epair ❑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 /> #of List of Fixtures #�f List of Fixtures #of List of Fixtures #of List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> A/C-Air Handlin 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 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/Mop/etc.) Other:
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<br /> Number of Heads
<br /> ACKNOWLEDGEMENT:/have reviewed this application and confirm the information contained herein is true and correct. 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 Official before being authorized under any circumstance.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made,
<br /> a I comply i the State ntractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT#
<br /> I� 2 ��O � � �'' �
<br /> Owner thorized gent Signature Date (Revised 9/23/2016)
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