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PERMtT APPLICATION <br /> BUtLDfNG!MECHANtCQL/PLUMBING/SIGN/SPRINKLER/ DEMOLiTtON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3240 CEDAR STREET,EVERETF,WA 882Q1 <br /> (P)425-257-8810 ( FAX 425-257-8857 �(E)everetteps@evereriwa.gov� wuvw.everettwa.gov/permiis <br /> {Blue or Black ink On.�y:Please) PROJECT SITE I,NFORMAT:ION. ' <br /> _ ;=. <br /> PROJECT SITE ADDRESS: ��(� j�Sf��7� PROPERTY TAX#: � f 7j j}�� <br /> LEGAL for new construction: Short Platlsubdivision Lot No. (attach copy of long legal description) <br /> . _ ,, . .: <br /> ; , <br /> ;:.COPITACT 1NFC?RMA"T{O.N <br /> .: <br /> QWNER NAME: "�~ ���/ TENANT NAME(If Commerciat): <br /> OWNER MAILING ADDRESS: srr�Eer �i�. S � � <br /> ClTY .� .+�'" STATE Z(p • g �• <br /> .: . . <br /> OWNER PHaNE: � U� "" � ��'�� OWNER EMAIL: : Yi � - (^� rc a��. . <br /> CONTRACTOR NAME: �•P� �Z� �,�. • SO ' i Gr <br /> CONTRACTUR ADDRESS: srnEer (f37�� `�`7� � �I,e/� <br /> q7Y .�� �p�} STATE �q( � ZIP <br /> CONTRACTOR PHONE: $� • �q`�c �.'�j S 3 CONTRACTOR EMAIL: i �. p- a <br /> CONTRACTOR UCENSE#(REQUIRED)c ��'L ,� 7,��� ClTY OF EVERETT BUSfNESS LICENSE#(REQWRED): d"r ' <br /> _.. ... ..... . _ <br /> PRtMARY CONTACT: �OWNER ��I.CONTRACTOR ❑OTHER(Pfease Specify) <br /> CQNTACT NAME: CONTACT PHONE: �,�- k,�`C�� �"'.7�,S 7� <br /> �i^ � . ,��. CONETACT EMAIL: � ` - � � � e t.��.n, <br /> , ,.. ,.: ,:. <br /> , <br /> BUILDING PERMtT APPi.ICAT{ON <br /> . -:. _. ;.: . , <br /> Existing Use of Buildin : QSc e�ri.�:�n ► Contract Price of Wo�k:$ " fl;,� <br /> Proposed Use of Building: i 1 Heat Source: Gas ❑Electric ClOther <br /> Buildin T pe: FR-Detached ❑SFR-Attached ❑Dupiex ❑Mufti-Family-#of Units �Commerciai �industrial <br /> Type of Project: ❑New OAddition ❑Remodel Repair ❑T.I. ❑Si n ❑Sprinkler ❑Demolition OChange of Use <br /> DESCRIP710N�F WORK: <br /> E-���2�<{r� �iv�c� t�,r`y.ar� y-��ac�;�✓t <br /> ASSOCIATED BUILDING PERMIT#{if applicable: <br /> > MECHANIGAL PERMIT APPLICATION: ':i -::'; ;:;.PLUMBING PERMIT APPLICATIQN ': `,'S ; <br /> Type of Project: _New Addn _Alteratfon �Repair Type of Project: New _Addn Aiteration _Repair <br /> Fi tu es �sf of Fixtures tixfures List of Fixtures ��u es ust of Flxtures F���eS Lfst of Fixtures <br /> A/C—Air Handlin Units Heat Pump Toilet Backflow Preventer(Inside Bld <br /> Forced Air Systems Unit Neater Bathtub Urina{ <br /> Gas Pi ing Boiler Lavatory{Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Dis osai Grease Tra <br /> Gas Ran e Ductin Dishwasher Roof Drains <br /> Ciothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Neater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc. Other: <br /> '`: SPRINKLER t SUPPRESS.ION:`SYSTEM. <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and con�rm the infom�afion conlained herein is frue and correct.Work done pursuant to this permit must comply with <br /> cuirent federal,state,and local law.The gwanting of a permit oniy authorizes approved work and no deviations therefrom.Deviations must Trrsf be authorized in writing from the <br /> Building O/lfcia!before being authobzed under any circumstance.I am the owner,or 1 am authorized by the owner of thfs propeKy to pe�form the work for which applicalion is made, <br /> and I comply with fhe State Contractors Law 18.27 RCW and 296.200A WAC. <br /> i <br /> '} City of Everett O�cia!Use Only <br /> j� PE 1 <br /> ,✓ � l�r O <br /> O ner Auth ed Agent Signature Daie (Revised 9/23/2016) <br />