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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� wvuw.everettwa.gov/permits
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<br /> PROJECT SITE ADDRESS: n c PROPERTY TAX#:
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<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
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<br /> OWNER NAME: �(D � � TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: s-raeer ( L,
<br /> CITY STATE ZIP a
<br /> OWNER PHONE: a 4�Q^ � � OWNER EMAIL: ��� �i`� T� /j�Q��/.C,QNj
<br /> CONTRACTOR NAME;
<br /> CONTRACTOR ADDRESS: STREET 7l�� Q � ��
<br /> CIN L, STATE ZIP
<br /> CONTRACTOR PHONE: ,�'7 7�- / CONTRACTOR EMAIL: /� (��G d A�
<br /> CONTRACTOR LICENSE#(REQUIRED): L.CIE � CITY OF EVERE7T BUSINESS LICENSE#(REQUIRED): ,f�
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<br /> PRIMARY CONTACT:��WNER �CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT N:v�-.��� �'�,(/l �Q� CONTACT PHONE: �Q�-� � l.y�o — � �
<br /> �djl.�. .�"�(��� '°' - CONTACTEMAIL: O' ' L
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<br /> „Mi, .��. _.� 116.C�.. , o, . ., �,�,�C,..'�' il i��.��� ,S�R„ YIiN�r,��
<br /> Existing Use of Building: Contract Price cf Work:$ �
<br /> Proposed Use of Buildin : Heat Source: uas lectric ❑Other
<br /> Buiiding Type: ; �6FF.3.9ataslaed- SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial
<br /> T e of Pro'ect: ❑New ,C�Addition ❑Remodel ❑Re air ❑T.I. ❑Si n ❑S rinkler ❑Demolition ❑Chan e of Use -
<br /> DESCRIPTION OF WORK:
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<br /> ASSOCIATED BUILDING PERMIT# if a licabie : �
<br /> � �NIECl�A CAL'� RMIT�AP,PL�C1#TIQNx�., ��,������K�'�� ���LUMBING�;PERM��� ,P,.e � AT107!1 ,.���*�� � •
<br /> �.N� ���M„�... °�
<br /> Type of Project: New Addn �,Alteration _Repair pe of Project: _New Addn Alteration Repair
<br /> #of ust of Fixtures #°f List of Ffi�ures #of 'st of Fixtures #of st of Fi�ures
<br /> Fixtures Fixtures Fixtuies Fixtures
<br /> A/C-Air Handling Units Heat Pump Toilet Bac ow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater Bathtub inal
<br /> � Gas Pipin Boiler ' Lavatory(Wash B ' ) Drinkin Fountain
<br /> Water Heater Refrigeration Shower Fioor Drain
<br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap
<br /> Gas Ran e Ducting Dishwasher Roof Drains
<br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas
<br /> Range Hood Water Heater er:
<br /> Exhaust Fan Sink Se ' e/Bar/Mop/etc. Othe.
<br /> ���„�o�k SPRIN��K�ER„�, ��E�S,ION�q�I�E��� w
<br /> Number of Heads
<br /> ACKNOWLEDGEMENT.•I have reviewed this application and confirm the lnformat/on contained herein!s true and correct.Work done pursuant to this permit must comp/y 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 wrfting 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 to perform the work for which applicailon is made,
<br /> and 1 comp/y with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use ONy
<br /> PERMIT
<br /> ' �~ � ( � l �� V�J
<br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015)
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