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� PERMIT APPLICATIO� <br /> BUILDIIV�/ 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 <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: � ��{� � r�m PROPERTY TAX#: <br /> � �t I} <br /> LEGAL for new construction: Short Pla ub�division Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: h � TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReer � <br /> cilv �t r'ti STATE W j'� ziP $ D <br /> OWNER PHONE: �p ' �(p 2, - �UO OWNER EMAIL: .�Ua✓� .i. {� b •Co.h <br /> CONTRACTOR NAME: �h ' � � � , <br /> CONTRACTOR ADDRESS: srReeT R b$ d(o re_ m "� <br /> CITY STATE � ZIP q <br /> CONTRACTOR PHONE: ,3(�(�> 5'?7 - ( �/ CONTRACTOR EMAIL: ,�kS�'i��lC Gl�' 'L � <br /> CONTRACTOR LICENSE#(RE4UIRED): �'/l% ���-�C � L; r 1� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): O�'l9 Z T� <br /> PRIMARY CONTACT: ❑OWNER f�[CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: 3�,�,5{-�� �N�tic�`vt. CONTACT PHONE: abb ' 3L��v - (o�gD <br /> CONTACT EMAIL: )µs�:.� 1( p,� CG�L�, ( �,c,. , y�f� <br /> BUILDING PERMIT APPLICATION <br /> Existin Use of Building: �or-a Contract Price of Work:$ O 000 •c� <br /> Proposed Use of Building: eJ�e�o�d�.�w` Heat Source: ❑Gas ❑Electric ❑Other <br /> Buildin T pe: ❑SFR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Famil -#of Units: ❑Commercial ❑Industriaf <br /> Type of Pro�ect: �New �Addition �Remodel ❑Repair ❑T.1. ❑Si n ❑Sprinkler ,�pemolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: 1 <br /> ��t�n o `��I^. 6w: �� -� �(S�as e. C�G6�:5 <br /> ���� <br /> ASSOCIATED BUILDING PERMIT# if a licable : <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn _Alteration Repair Type of Project: New Addn Alteration _Repair <br /> #of List of Fixtures #of ��st of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtu�es Fixtures Fixtures <br /> A/C-Air Handlin Units Heat Pump Toilet Backflow Preventer(Inside Bld ) <br /> Forced Air S stems Unit Heater Bathtub Urinal <br /> Gas Pipin Boiler Lavato (Wash Basi�) Drinkin Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Ran e Ducting Dishwasher Roof Drains <br /> Ciothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink Service/BadMo /etc.) Other: <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:i have reviewed this applicatron 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 permif only authonzes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official be being authorized under any crrcumstance.1 am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply ' the tate Co trectors Law 18.27 RCW and 296.200A WAC. <br /> � City of Everett O�cial Use Only <br /> // / PERMIT#� ��� <br /> , � � <br /> er horize A nt Signature Date (Revised 9/23/2016) <br />