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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� www.everettwa.gov/permits <br /> �B1,r��..or Blac.k ink Only`��eas�� PROJECT SF'�E 11�F�1lil�k7'ION. ' <br /> PROJECT SITE ADDRESS: 2�Q � 'E PROPERTY TAX#: C��3���P��U�(7 C' <br /> LEGA�for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> GON�"ACT �NFaRNfATiON; <br /> OWNER NAME: S �� h�' r••E G'��� TENANT NAME(If Commer 'al): � d���° <br /> OWNER MAILING ADDRESS: srREer Z�D7 G�L�7��� v Z � cyt 7�.. / � <br /> aTv srn� �i(�� ziP '7��� <br /> OWNER PHONE: �LS ZS�"S�O(' OWNER EMAIL: daYe r'Qe�� S/C�a�G�ii�G7fY1 <br /> _ <br /> CONTRACTOR NAME: c..�1v��C�'�(�J �"�C= /I�QA--°/�,S <br /> CONTRACTOR ADDRESS: srReer �/1� �!j �V� Sa � �JZ' <br /> � � CITY W�' Q� STATE � � 21P . � � . <br /> CONTRACTOR PHONE: SD,� �(� -OS7S CONTRACTOR EMAIL: hld/�'y$�G{rltte�^�'�- <br /> CONTRACTOR LICENSE�#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(RE IRED): y g <br /> . , � � , . ,� ,� ,� �_,,,. .�_ �. _.. _„ . ,__, _ _ .�� <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR OTHER(Please Specify) I 6W <br /> CONTACT NAME: ,t CONTACT PHONE: 9'ZS. q 7�-� U72. <br /> �I� L.SU N d`��' t�'!� ��ZA��O� CONTACT EMAIL: 1� lZGt �A�Sano�I�in� . <br /> � � � BUILDIN6�PERM�t.APPLICATION ���� � <br /> Existing Use of Building: � Contracf Price of Work:$ �(� d�v <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 OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> �,�„�,,� 2 �,�.�,� ��,,,`n� <br /> ASSOCIATED BUILDING PERMIT#(if ap licable : <br /> ' MECHANIGAL PERMIT APPLICATI ,�- PLUMBING PERM �APPL ATION <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 #°f ist of Fixtures <br /> Fixtures Fixtur Fixtures Fi es <br /> A/C-Air Handling Units p Toilet k w Preventer(Inside Bidg) <br /> Forced Air Systems i Heater Bathtub U <br /> Gas Pipin oiler Lavato (Wash Basin D king Fountain <br /> Water Heater Refrigeration Shower loor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&D' osal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer ookups Other: Clothes W er Medical Gas <br /> Range Ho Water ater O#her: <br /> Exhaus an Sin ervice/Bar/Mop/etc.) Other; <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this applicafion and confirm the information contained herein is true and correct.Work done pursuani to this permit must comply with <br /> current federal,state,and local law. The grenting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this properry 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 /> Ciry of Everett Official Use Only <br /> � 7 � �7 P�C# <br /> ��� <br /> Own lAuthorized n ignature Date (Revised 9/23/2016) <br /> �v � <br /> -M,__..,���"` <br />