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PERMII'APPLICATION <br /> Bl11LDING /MECHANICAL/ PLUMBING /SIGN /SPRINFCLER/ DENiOLII'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 Onty Please) PROJECT SITE INFOIZMATION <br /> PROJECT SITE ADDRESS: �Z t� Go�(lMbr'q AVe, �v�°ir*�f- �/� �7A PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legai description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 0�''IIn j� �tAr"n TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReeT �? ���J /�✓e S� <br /> ciTv �A�e S .� STATE W� ziP 9�7i�� <br /> OWNER PHONE: �1�i5r���"' 7 I� OWNER EMAIL: OMO�ivk�qr•�e, � tioo.�%d�I <br /> CONTRACTOR NAME; B�✓ ��'P-1^A(i�'i�1 <br /> CONTRACTOR ADDRESS: srReer "I S j� � � S7�' � �I � rl�� <br /> CITY � �J�DO STATE �I� ZIP �7 <br /> CONTRACTOR PHONE: �ZS �L�D �y� CONTRACTOR EMAIL: W �jDI,��'�1G�`'l�j �/.� �U , GO <br /> CONTRACTOR LICENSE#(REQUIRED): l7�� 'I Z-� ��I � CITY OF EVERETT BUSINESS LICENSE#(REQUIR <br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �y —3�7-. ��+� <br /> �brI!/��LII �'1 �� CONTACT EMAIL: �� � +� L,q r � , �j�� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ��i v� Contract Price of Work:$ �0 ¢��'� <br /> � <br /> Proposed Use of Building: j''(�l�P.l°tGe Heat Source: ❑Gas lectric ❑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 /> ��� S�d-;n�� �('s�-�►e�t rc-�r o�� r l�a f�ro��"1 ,►Q�v e. . <br /> r��� S��Por�f- �eEr�►�, <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATIO <br /> Type of Project: _New _ Addn Alteration Repair Typ of Project: _New _Addn �Alt ti _Repair <br /> #of List of Fixtures #of List of Fixtures #�f List of Fixtures #of List of Fi�ctures <br /> Fixtures Fixtures Fixtures Fixtur <br /> A/C—Air Handling Units Heat Pump To'et B ow Pre e er(I ide Bidg) <br /> Forced Air Systems Unit Heater B thtub U inai <br /> Gas Piping Boiler avato a in) rinking Fo tain <br /> Water Heater Refrigeration owe Fioor n <br /> Gas Fireplace Wood Stove C Kitc n Sink Dispo I Gr e <br /> Gas Range Ducting ( Dishwa er Drain <br /> Clothes Dryer Hookups Other: [ Clothes her Medical Gas <br /> � Range Hood Water Heate Other: <br /> Exhaust Fan Sink(Service/ ar/Mop/etc.) Other. <br /> SPRINKLER 7 SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads ' <br /> ACKNOWLEDGEMENT.�l have reviewed fhis applicafion and confirm the information contained herein is true and correct.Work done pursuant to this permit must compiy with <br /> current federal,state,and local law. The anting 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 autho� d under any circu Eance.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply�vith the State Co cfors Law 18.27 and 296.200A WAC. <br /> City of Everett Officia!Use Only <br /> , '� <br /> �//�/�� PERMIT# I� o ��O� <br /> � <br /> Owner/Autho Age Sign re Date (Revised9/23/2096) .� <br />