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PERMIT APPLICATIOI� <br /> �UILDING / IVIECHANICAL/ PLUMBING /SIGIV 1 SPfZIIVKLER/ 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�lack Ink Only Please) PROJECT�ITE INF6RM1�7'IOIV <br /> PROJECT SITE ADDRESS: �� � �/�YQ ,��Q, PROPERTY TAX#: � � O (� Z <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATIAPJ <br /> OWNER NAME: �oL�I �J.Q( -Ja- 1,�,�.• u NT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: sTReer 3C���- �ZA'�I �`` S}, S� <br /> CITY " n n W y^,J� STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: jrG►pi��Qu � (�(�� /y1GCiI•(oi�✓1 <br /> CONTRACTOR NAME; p�so� '�y" �� 3 �p � Ot� <br /> CONTRACTOR ADDRESS: s-rReer a� (� r g9�^ � ,s1.1� � �pb Q Z <br /> ci'�' L {+(Y�utt JJa�" STATE �,,1/A- zia � B(��J� <br /> CONTRACTOR PHONE: �C� r(l7 Z" �I�I'� CONTRACTOR EMAIL: �yc��/�an11 fquVsc.'✓C•vLtS�}YuGfi�rn �t; > a <br /> CONTRACTOR LICENSE#(REQUIRED):�'J 'A�� C �� ��Z, CITY OF EVERETT BUSINESS LICENSE#(REQUIR <br /> PRIMARY CONTACT: ❑OWNER ,�CONTRACTOR ..�OTHER(Please Specify) O r 55 �� 2 - S`/�} <br /> CONTACT NAME:TU rf r+,��S CONTACT PHONE: � Lj'Z,� ., Cj � <br /> �I/ C's�� <br /> CONTACT EMAIL: ��r� �uS5 � �e(�,�s EOY✓1 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ ��' �— /8 � <br /> Proposed Use of Buitding: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: FR-Detached ❑SFR-Attached ❑Dupiex ❑Multi-Family-#of Units: ❑Commercial ❑Industriai <br /> Type of Project: ❑New ❑Addition emodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: '�-��� �prno�( _ (MbVah S,f.�� '� �u5 �� ��« v�� ���-�` <br /> C.[o��n ��, ��t I� G�0 DY�nJ� � ��f �G�,� '� ��B� �v►af�.�- cP�o�.,t��.� ��.. � U.�,rr , <br /> ,A���i�^,. �J'�� �'t�DIL U� �^ �1�2- �IGt�(W� Gt�� G�l�ch5�'+�l_ O Wi- �i l.e�-. �'�G� S w a 1 t <br /> ASSOCIATED BUILDING PERMIT#(if applicable): S <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICEITION <br /> Type of Project: _New Addn _Alteration _Repair , Type of Project; _New _Addn �Alteration _Repair <br /> #of Lisf of Fixfures #�f List of Fixtures #°f List of Fixfures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump J Toilet Backfiow 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(ServicelBadMop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No. ofi Heads <br /> ACKNOWLEDGEMENT.�1 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,sfate,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in wrifing from the <br /> Building Official before being authorized under any circumstance.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 w the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ., /� � '� PERMI # � �r � y1 <br /> lJ <br /> Owner/Au ized Agent Signature , D te (Revised 9/23/2016) <br /> , I � <br />