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I ��RmiT A�PLicATio� <br /> BUILDING / IVIEGHANICAL 1 PLUM�IfVG /SIGN /SPRItVFCLER/ 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 INFOItMAT1AI�1 <br /> PROJECT SITE ADDRESS: `7'� �`,��C�!�l�v2- L(�I PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTAGT INFORMATION <br /> OWNER NAME: (,O jc 0��1/l�W TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReEr � 1�� ���1,.3'M'v��L. C. <br /> CITY Gr-�/ fr���.� STATE '��� ZIP 9 Q �� <br /> OWNER PHONE: t7 ��� �e 2, Q OWNER EMAIL: <br /> CONTRACTOR NAME; ��^ G4 v �� ��V �� �JI�I.��u�'�l�^L+� C� <br /> CONTRACTOR ADDRESS: sTReer�04 y ��1N1�i2 (��> -�}' ��a f <br /> CITY �W�'�i.l1 STAT�/f/-J ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED):�7 COC �a � CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):�� <br /> PRIMARY CONTACT: WNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Z O �p �y� Cl� Z 9 <br /> � � ���'� CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 1�" Contract Price of Work:$ `—r <br /> Proposed Use of Building: Heat Source: Gas ❑Electric ❑Other <br /> Buiiding 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: /��)�` �d, t f1 �� ���/J�� �.��^�� � <br /> v/vv /\ J J � <br /> L.1�C� {'2 ti����J'��'`�� t.� ��� <br /> ASSOCIATED BUILDING PERMIT# if a plicable): <br /> MECHANICAL PERMIT APPLICATION PWMBING PERMIT APPLICiATION <br /> Type of Project: _New Addn Alteration Repair Type of Project: New _Addn _Alteration Repair <br /> #of List of Fixfures #�f List of Fixfures #°f List of Fintures #°f Lisf of Fixtures <br /> Fixfures Fixfures Fixfures Fintures <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: 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 frue and correct.Work done pursuant to this permit must comply with <br /> current federal,sfate,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 circumstan . he owner,or I am authorized by the owner of this property fo perform the work for which application is made, <br /> and I comply with the State Contra ors Law 18.27 RCW 296.20oA AC. <br /> City of Everett Official Use Only <br /> 0��� ��Z��` j� PER T# �>�V c✓� <br /> �(/ <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />