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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBlNG/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� wuvw.everettwa.gov/permits <br /> ;:(Blue:oir;Black 1�rik On1y,Rlease) " , PROJEG�''SITE il±IF.ORMA'ftOAl "-- <br /> _ , : . �, �_ , , <br /> PROJECTSITEADDRESS: �l�ZSGD�I� �vl�. PROPERTYTAX#: �n�3�I�7�j?D( ZOO <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFt3RMATiUN <br /> OWNER NAME: �� � TENANT NAME(if Commercial): G <br /> OWNER MAILING ADDRESS: sTReeT ?i�/�� V�G �C �{,. li OO <br /> ciTv �/'+l/`� srnre w/� vp�8 ZG� � <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME. --�' <br /> CONTRACTOR ADDRESS: s-rReer <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): � L CITY OF EVERETT BUSINESS LICENSE#(REQUIRE ): ` <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR �OTHER(Please Specify) �f'G t GG <br /> CONTACT NAME:�aY�1 G !� D W � CONTACT PHONE: 2� ZGJ Z��,(5?> <br /> �5�� A�G'�������' CONTACTEMAIL: dqy�� G�lt. �ZSt2a�ro�r►�'t'+C,` M,�'�,.LpW� <br /> BUtLDING PERMIT APPLICATION <br /> Existing Use of Building: �G�i- Contract Price of Work:$ �Gi ��� <br /> Proposed Use of Building: � ��G� 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 epair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: . ^� / ^ <br /> �P�AI� �'l`r'� VA���P. �'� 7u��'Q !'�' G1v`� �'✓�:}{,�j C�V1 <br /> ��� �loo� o� �x.s'r. b��9 • 2, 2 78 s��: -}�fa I. � <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 Lisf of Fixtures ��f List of Fixtures #°f List of Fixtures #of List of Fixt s <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow enter(Inside Bldg) <br /> Forced Air Systems Unit He r Bathtub Uri <br /> Gas Piping Boi Lavatory(Wash Basin) rinking Fountain <br /> Water Heater efrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookup Other: Clothes Wash Medical Gas <br /> Range Hood Water He r Other: <br /> Exhaust Fan Sink rvice/Bar/Mop/etc.) Other: <br /> $PRIN' ER•/%5U1'PI��SSl.ON SYST.,EM <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 deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.1 am the owner,or I am authorized by the owner of this property fo perform the work fo�which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> � /� � 7/�//� PERMIT � �� <br /> V <br /> Owner/Authorized Agent Signatu Date (Revised 9/23/2016) �r�� <br />