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PERM17 APPLIC/�iTION 'I,'I <br /> BUILDINC�IIIECHt4NICAL/ PLUMBIMG /SIGN /�4'KtNKLER/ 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 /> (Blue or Black Ink On1y Please) PROJ�CT SIYE INFORMATI6M <br /> PROJECT S1TE ADDRESS: Z� I � � ��' � PROPERTY TAX#: �,9G�SyI�D� jO�ZQ� <br /> LEGAL for new consfruction: Short Plat/subdivision Lot No. (aftach copy of long legal description) <br /> CONTACT INFORMATIOId <br /> OWNER NAME: ���LL"'T� (�v�i (., �-�i��} , TENANT NAME(If Commercial)� <br /> OWNER MAILWG ADDRESS: sTReEr �'j � �'C„ <br /> Cm' �" �-�G STATE W 1I+� ZIP � �✓I <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME; �'�� <br /> CONTRACTOR ADDRESS: srReEr <br /> ��n' srnre zia <br /> CONTRACTORPHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(RE4UIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: f..fZ j-- 2�"3 .. � � '�"�i ��,i�, <br /> ��4�4-�J � ��}`"—�j� CONTACT EMAIL: ,f-���1 � � ,�t/ � � � <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: �-M� "}S Contract Price of Work:$ 12 7 U v <br /> Proposed Use of Building: S1�-�v�� Heat Source: ❑Gas ❑Electric ❑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 /> ASSOCIATED BUILDING PERMIT#(if applicable): �!��� � �x• .,Q./'ti <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn _Alteration Repair Type of Project: _New _Addn ,_Alteration Repair <br /> Fixfures Lisf of Fixtures Fixtu es �st of Fixfures #of Lisf of Fixtures #°f List of Fixfures <br /> Fixtures Fixfures <br /> A!C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bidg) <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&Disposa� 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.�1 have reviewed this applicafion and confirm fhe information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> cument federal,state,and local law.The granting of a permit only aufhorizes approved work and no deviations fherefrom.Deviafions musf first be aufhorized in writing from the <br /> Building O�cial before being authorized under any circumsfance.I am the owner,or 1 am aufhorized by the owner of this property fo perform the work for which application is made, <br /> and 1 comply wifh the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett O�cial Use Only <br /> ` — ��-- �, � � PERMIT (�V�'D <br /> � � � <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2096) �y� <br /> !�-- � <br /> � <br />