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PERMIT APPLICATIOt�
<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 /> (Blue`or Black InkiOnly Please),. ;,; PROJEC7rSITE INFORMATION„`., „j„ ' . ,;
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<br /> PROJECT S1TE ADDRESS: p��j j(� - � ,� ��S L�vE/I,�l PROPERTY TAX#:
<br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description)
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<br /> _! .. ..; : _ .;CONTACT NFORMATION. , : _. ::
<br /> OWNER NAME: �sj TENANT NAME(If Commercial): r--�"`�
<br /> OW MAILING ADDRESS: srReeT " C7 '7 � s S�-"
<br /> �vy Lr �� CIIY STATE � .�-"—' ZIP q�f'2�3
<br /> OWNER PHONE: ZS ''�J ^' ZQl I � OWNER EMAIL: t�{-/2-�-� � II U��
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<br /> CONTRACTOR NAME: ��V
<br /> CONTRACTOR ADDRESS: srRee-r
<br />� CITY STATE ZIP
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify)
<br /> CO CT NAME: CONTACT PHONE: �5 --���
<br /> � �. ti'�1� CONTACT EMAIL: "�"
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<br /> �.,._ . ; . ' . ,,._ ., ..T...:... ..�< �'; ,BUILDING';PERMIT APPLICATION .,.;; ... w.�,�' � `
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<br /> Existing Use of Building: (L� p � Contract Price of Work:$
<br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other
<br /> Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial
<br /> Type of Project: New ❑Addition ❑Remodel Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:/�o�YCi�G� ��[j�lN✓�� ��
<br /> ASSOCIATED BUILDING PERMIT# if applicable:
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<br /> MECHANICAL,PE,RMIT APPLICATION ` ` PLUMBING PERMIT APPLICATION ,„ „ ' ,., ' `
<br /> Type of Project: _New Addn _Alteration Repair Type of Project: _New _Addn _Alteration _Repair
<br /> #of usf of Fixtures #�f List of Fixfures #of List of Fixtures #°f List of Fixfures
<br /> Fixtures Fixfures Fixtures Fixfures
<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 Founfain
<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/,,,Y.,SUPPRESSION SY$TEM ' _
<br /> Number of Heads`
<br /> ACKNOWLEDGEMENT.•1 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 fherefrom.Deviations must first be authorized in writing from the
<br /> Building Official before being authorized under any circumstance.l am the owner,or 1 am authorized by the owner of this property to perform the work for which applicafion is made, '
<br /> and 1 com ly with the State Confractors Law 98.27 R W and 296.200A WAC.
<br /> City of Everett O�cial Use Only
<br /> J�, ��l PERMIT# I�/�+ ���
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<br /> wneriAu r' d Age ignature Date (Revised 5/20/2016)
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