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PERMII'APPLICATION <br /> BUILDING/ MECHANICAL/ PLUMBING /SIGN /SPRINFCLER/ 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 <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: j�� ,� �� PROPERTY TAX#: <br /> , <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ��,y�, ,Pj (/LS TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s-rReeT <br /> CITY " STATE ZIP <br /> OWNER PHONE: — 3�-�(� 3 3 OWNER EMAIL: <br /> CONTRACTOR NAME, <br /> CONTRACTOR ADDRESS: sTReET �`yt <br /> CITY � � STATE ZIP <br /> CONTRACTOR PHONE: �6-� �- y CONTRACTOR EMAIL: �'G�r `U(�,p�pp a�O� <br /> CONTRACTOR LICENSE#(REQUIRED): ��� � CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):�3 <br /> PRIMARY CONTACT: ❑OWNER ,�CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAIUIE: ��� dtQmS LCe� CONTACT PHONE: �6_ �3._� <br /> ��� �Q��y CONTACT EMAIL: �G� G Q.�� . �� <br /> BUILDING PERMIT APPUCATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex �I�Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: New �Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTIO OF WOR�:`}��, � „� �,�^� �� � e�� �?, fX�6 Sbt�� ��� � <br /> ����1 � a,,�r�— , - <br /> .�.�w D�z,y� ay k,t,�� �� h��.v 30 �r �i^��, <br /> s�e�� <br /> ASSOCI TED BUILDING PERMIT#(if a plicable): <br /> MECHANICAL'PERMIT APPLICATION PLUMBING PERMIT APPLICiAT10N <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 Ust of Fi�ctures #°f Lisf of Fixtures <br /> Fixtures Fixfures Fixfures Fixtures <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 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. <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No. of Heads. <br /> ACKNOWLEDGEMENT.•I 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,stafe,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 I am authorized by the owner of this property fo perform the work for which application is made, <br /> and i comply with the State Contractors Law 98.27 RCW and 296.200A WAC. <br /> � of Everett Official Use Only <br /> r---- <br /> ���.G��4' ` � 3� ! / PER T�IJ\I ' V�� ��'��O � <br /> �S <br /> Owner/Authorized Agent Signature te (Revis d 9/23/201 <br /> ,_ <br />