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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 /> (PJ 425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> {Biue or Black I�k On1 Pl+e�se)` PROJECT SiTE fNFi!►�MA'L'iON, ;' <br /> PROJECT SITE ADDRESS: J'S�I W(� AVGNU� �1/(,IL�� PROPERTY TAX#: OO� '�j,.�j n Z. <br /> LEGAL for new construction: ShoR Plat/subdivision Lot No. (attach copy of long legai description) <br /> CONTACT INF�RMATION• <br /> OWNER NAME: JO D f 2, SL�.V I�C-S TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReeT �/ <br /> CITY � STATE ,N�Q ZIP � �.Q <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME; (,,G. ����"� V� <br /> CONTRACTOR ADDRESS: s-rREer 'L !�'I� �{� � <br /> � CITY STATE ZIP � <br /> CONTRACTOR PHONE: � Z7j'Z '� CONTRACTOR EMAIL: A(�G-y D � <br /> CONTRACTOR LICENSE#(REQUIRED): �j ��L CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: -(',6)lI,'��j�D'Y- CONTACT PHONE: 1.�jyj 2'1>2 �j°-�?) <br /> CONTAC7 EMAIL: A�, �D G � �.�n►Y <br /> ' BUtLDING PERMIT-APPlIG�[`TfON .-; - <br /> Existing Use of Buildin : !�. Contract Price of Work:$ � <br /> Pro osed Use of Buildin : J F� Heat Source: ❑Gas ❑Electric Other <br /> Buildin T e: �SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Famil -#of Units: ❑Commercial ❑Industrial <br /> T e of Pro'ect: ❑New �Addition • Remodel ❑Re air ❑T.I. ❑Si n ❑Sprinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: <br /> I nl Si'b�t� 1�l��'1/� ��fi�l�YI SI N I�— ` �L I N STq7,c_, ��,t G�'1—" <br /> �NS-ha w. �iP.a,J� '�o�.� �,oU� C:n v�u2 <br /> ASSOCIATED BUILDING PERMIT#(if a licable : <br /> MECHANICAL PERM1T;ApPLICpT10N PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: _New Addn Alteration _Repair <br /> #of List of Fixtures #of u�of Fixtures #of ust of Fi�rtures #of List of Fixtures <br /> Fixtures Fi�ctures Fixtures Fixtures <br /> A/C-Air Handtin Units Heat Pump Toilet Backflow Preventer(Inside Bld ) <br /> Forced Air S stems Unit Heater Bathtub Urinal <br /> Gas Pipin Boiler Lavato (Wash Basin) Drinkin Fountain <br /> Water Heater Refri eration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Ran e Ductin Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink(ServicelBar/Mop/etc. Other: <br /> sPRrN�c�e�t i su�!�r�i�ss�aN sYsrenn <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:I 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/ocaf law.The granting of a pertnit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Officia/before being authorized under any circumstance.I am the owner,or/am authorized by the owner of this property to perform the work for which application is made, <br /> and!comp/y with the ate Contractors Law 1 RCW and 296.200A WAC. <br /> City of Everett O�cia/Use On/y <br /> 1�I I `)� PERMIT# � L G ! W1� <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) r <br /> 1 <br />