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PERMIT�4PPLICATION <br /> �UILDING / MECHANICAL/ PLUM�IfVG /SIGN /SPRIIVKLER/ DEMOLII'ION <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 /> {�lue or�lack Infc Only Please) PROJECT SITE IIVFORMATIONI <br /> PROJECT SITE ADDRESS: .�%�7 G�� � ��(JQ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision �� Lot No. (attach copy of long legal description) <br /> GONTACT INFORMATION <br /> OWNER NAME: ��,Q�L� j'�'/UTU�� �L� TENANT NAME(If Commercial): �-�- <br /> OWNER MAILING ADDRESS: sTReer (�Q �C l,J-`Z�� <br /> CITY � � STATE �� ZIP 2� <br /> OWNER PHONE: "ZS=Z5 Z'j�Ff�O OWNER EMAIL: /�12,T P.> r�-'�p't'�/�-L, � [pfy� <br /> CONTRACTOR NAME; p� '���'(.�- <br /> CONTRACTOR ADDRESS: sraeeT �,()�� �2..G�� <br /> CIN [�"/c.�t . K//J- STATE �t/0�,� ZIP -/ d" G-(Q CJ <br /> CONTRACTOR PHONE: �Z'� '2 —��4t�D CONTRACTOR EMAIL:�"Y�''�� ��°-0'rmA'� � �� <br /> CONTRACTOR LICENSE#(REQUIRED): "� (�(,/�}}'t/� (� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Piease Specify) <br /> CONTACT NAME: CONTACT PHONE: J,.�Z - -Zz�.'Z'S �-Q <br /> �'�,rr (� (� �p/1"(�.� CONTACT EMAIL• �-i�? � ��i�'Z'j'�� �, ' �!/f/I <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ' t� Contract Price of Work:$ � �l �Q� <br /> Proposed Use of Building: (��f C,�-•- Heat Source: as '�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: �Q���� <br /> rS V�D � C �..r.r Q��'�'i���� l¢`� l��'� <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 List of Fixtures #�f List of Fixtures #°f Lisf of Fixtures #�f List of Fixfures <br /> Fixtures Fi�rtures 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: Clofhes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.�1 have reviewed this application and confirm the informafion contained herein is true and correck Work done pursuant to this permit must comply with <br /> current federal,state,and local law.The granting of a permit only aufhorizes approved work and no deviatrons therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being autho�ized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Evereft Official Use Only <br /> � PERMIT# <br /> � � � � O � �� <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) �� <br /> � � <br />