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PERMIT APPLICATIOt� <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ 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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: J Z� Ct?l� � ��C 1P� /� PROPERTY TAX#: <br /> LEGAL for new construction: Short Platlsubdivision Lot No. (attach copy of long legai description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ,� � Q��i.S r � � ,( C��ENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReer <br /> CITY " STATE ZIP ' <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME; 5�/.-. <br /> CONTRACTOR ADDRESS: sTReer E f yD� �7�' <br /> CITY �,� ( STATE � ZIP ��O � <br /> CONTRACTOR PHONE: �Z�- � — yY�� CONTRACTOR EMAIL: �e5u.t ,�i U�j.�vK Gv.. � <br /> CONTRACTOR LICENSE#(REQUIRED): �`j ��j��. CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):�Z Fj <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: z�� � �/_ f�/� 3 <br /> ��5� v�jS�� GONTACTEMAIL: ` u)G� � y��-te rv�S�� v-i-v"^- <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ K <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: <br /> ���-��� ,�.� �,�.) ��.Y.. � d�.��� �-.,� �u./��'�. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PWMBING PERMIT APPLICATION <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: _New _Addn _Aiteration Repair <br /> #of List of Fixfures #of Lisf of Fixtures #of List of Fixtures #�f List of Fixtures <br /> Fixfures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Z 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 /> SPRINKLER/SUPPRESSIAN SY$TEM <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 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 /> euilding O�cial before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this properfy to pertorm 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 /> � � � <br /> wner/Authorized Agent Signature Date (Revised 9/23 016) <br />