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PERMIT APPLICATION <br /> BUILDING/ MECHANICAL/ PLUMBING /StGN 1 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 <br /> (Blue or BlaakJnk Only Please) PROJECT SITE iNFORMATION <br /> PROJECT SITE ADDRESS: �O 11�� �s"7' S�. �2�' !�I� ��J� PROPERTY TAX#: <br /> LEGAL for new consfruction: Short Piatlsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: LCS�i L m�7-(�t�� ( TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s-rReer j(� �3`� T S� <br /> � CITY �jJ.P�,('� STATE �J7 ZIP RQo1.U� <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME; U L�,n�e-!^ <br /> CONTRACTOR ADDRESS: s-rReer <br /> CITY STATE ZIP � � � <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED); CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMAI2Y CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLIGATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Pro�csad Use of Su�i!d;I^g: HeSt Seu!'C�: ❑G?S C1Flectric ❑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: ��S��Q,� .w� l(� � �.��-},� l( y���,,pa �1 i ��:�,e� a v�e( �l ►ti�ly ,ro a <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: _New Addn Alteration _Repair <br /> #of Lisf of Fixtures #�f List of Fixfures #°f List of Fixfures #�f List of Fixtures <br /> Fixfures Fixtures Fixtures <br /> A/C—Air Handiing Units Heat Pump Toilet I er(inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub U <br /> Gas Piping Boiler Lavatory(Wash Basin) Fo t <br /> Water Heater Refrigeration Shower o n <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Tr <br /> Gas Range Ducting Dishwasher ' s <br /> Clothes Dryer Hookups Other: Clothes Washer Ir <br /> Range Hood Water Heater Othe : <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> , SPRINKLER/SUPPRESSION $YSTEM' <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.�l have reviewed this applicafion 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 firsf be authorized in writing from the <br /> Building O�cial before being 8uthorized under any circumstance.l am the owner,or I am authorized by the owner of this p1'operty to pertor'm the work for which application is made, <br /> and!comply Wjth fhe State Contractors Law 18.27 RCW and 296.20oA W.4C. <br /> City of Everett Otficial Use Only <br /> � n � PER <br /> `� �C�<,C m..�.Q,� �0 3 �a� 1 r� � n� - OO <br /> Owner/Autnorizea Agenc Si9Raj�Ce Date (Revised 9/23/2096) <br /> •� <br /> � <br /> \ <br />