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� PERMIT APPLICATIOf�
<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
<br /> ��e���=E�a����`Q*��y��s�) �'ROJEfi��13'��FO'l��E�'�IOI� ��__ _ " '�� � _"� �_ f
<br /> PROJECT SITE ADDRESS: '��� �� L�}4 �S - � PROPERTY TAX#:
<br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description)
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<br /> ..�� ,�.�� .: -�_ �.� .��., � �,� CQNT�T���`���rAT��1';,fi :f,,�.,.,�. � ���,� �,„�,.�ti�,:,,..�
<br /> OWNER NAME: � e,. (�,,3 TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: s-rReeT Z7 ��j
<br /> CITY �j(/fi�G.� STATE ZIP g�(�/
<br /> OWNER PHONE: �Z�-�jy`�- /'7Z OWNER EMAIL: ��e�,° � ry�u, .Lo,�►
<br /> __�__._. ______ _.
<br /> _ . � _ ___ __ . : _._
<br /> CONTRACTOR NAME; � �/s� ,��s T�`���,;,y�
<br /> CONTRACTORADDRESS: srrtee-r %y o (7v-rA� (�l✓�Q.
<br /> ciTv C v�I STATE� zta $Z I
<br /> CONTRACTOR PHONE: �p (p�j-7�"jGk� CONTRACTOR EMAIL: ��..�,;r f��ttii°/,Ca,�/
<br /> CONTRACTOR LICENSE#(REQUIRED): ��,�'�,��6,� �.T CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):0��3��
<br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME:��� �,f�'�,� CONTACT PHONE: �/��_ ��'r-r'_/�g
<br /> CONTACT EMAIL: K'o�,,,(1 ,�{�f�S �Gr�,l.CmryJ
<br /> _ P�`"^`�`^� L yq ���f -"�,� t� �����.l�`�������-�rll,"��`�V��,�� _ `-'�� Yi*{ "i'=£1 k*'y sE -
<br /> Existing Use of Building: '� Contract Price of Work:$ �U��J•�
<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: f�5 ti�� ��S f�+3�✓ P�vS ,S�vI7b �ar ��� NzG� %ti��F � GJa(S'��'�^e.-
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> .r.. _I111E��A�!11��1`L_PER.11�.1'�'A.P,,�?!�I�ATIQ�!I� ,; ,.,;: r, �;... ; �'�,UMBI��;PE��IfI�'_AP„R°,Ls��ATtQ�+1:...' �
<br /> ;.
<br /> Type of Project: _New Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair
<br /> #of List of Fixfures #of List of Fi�ctures #of �)st of Fixtures #of List of Fixtures
<br /> Fixfures Fixtures 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 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 /> ,SPRfi�KLER��y�UPP�ESS101�C,SYSTEiV�;
<br /> Chemical or Water No.of Heads
<br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm fhe information contained herein is true and correct. Work done pursuant to this permit must comply wifh
<br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviafions therefrom.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 application is made,
<br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT#
<br /> � � B 3� I� Og� 05
<br /> O ner/Authorized Agent Signature Date (Revised 9/23/2016)
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