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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 /> ��lue;or Black lr��i��ly hlease) ; . ; P1���E�CT SI`TE INFORM/kTll�N, : <br /> PROJECT SITE ADDRESS: 2 O Z G o � �1� �V Ci PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION " <br /> OWNER NAME: ��, �� ��I i'a yV�. I TENANT NAME(If Commercial): G, Gp� <br /> OWNER MAILING ADDRESS: sTReer <br /> ciTr srnre zia <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME:. .Gj'/ _ l ' �'. _ <br /> T , <br /> CONTRACTOR ADDRESS: srReeT L� � /�1,-�, �L'� <br /> cirv �j i'��G� STATE (�� ziP Z 7 I <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): ^r � ��� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> __ �� ,. _�._.. _ <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUlLDING PERMIT APPLICATION <br /> Existin Use of Buildin : Contract Price of Work:$ � �� <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Buildin T pe: ❑SFR-Detached ❑SFR-Attached ❑Dupiex ❑Multi-Famil -#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 /> ��w��r.C� �exavv� ro�s, 1 res�ra�.� a.d� r� f�ew �ir,�,s (�, l►�°�o�,�l <br /> �h�ASSOCIATED BUILDING PERMIT# if a licable: � —� ��� <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 Fi�ctures #of Vst of Fixtures #of /�sf of Fixfures #of /ay�of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handlin Units Heat Pump Z Toilet Backflow Preventer Inside Bldg) <br /> Forced Air S stems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refri eration 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/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•I have reviewed this application and confirm the information contained herein is true and carect.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 irom the <br /> Building O�cial before being authorized 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> � Ciry of Everett O�cia/Use Only <br /> � /���/ PERMI I L���� V�� <br /> Ownerl orized Agent Signature Date (Revised 9/23/2016) <br />