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PERMIT APPLIC/�TION <br /> BUILDING /�IICHAMICAL/PLUMBING/SIGN I S�KLER/ DEMOLITIOtV <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@evereftwa.gov� www.everettwa.gov/permits <br /> (Blue or Black Ink On1y Please) PROJECT SIYE INFORMATIOPI <br /> PROJECT SITE ADDRESS: �...��L.I ( 2� �) PROPERTY TAX#: �,G}C?S�I�DU JQ� �(�!� <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (aftach copy of long legal description) <br /> CONTACT IfHFORMATION <br /> OWNER NAME: �"Lr't�G'�� (�t,is� (-s �`(,�i"�� , TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReEr �j �j � <br /> C� ����1.. � STATE �/�/iI+'- ZIP � G_.L!1 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: T�� <br /> CONTRACTOR ADDRESS: sTReEr <br /> C� STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERE7T BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �Z j-- 'Z�"� .. � ` 'r�� ��,�i�, <br /> ��41'Ps.� � `�—�i�, CONTACT EMAIL: ,f-�Y�.� ►'\ � .Q� � , f5 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: �-�� }� Contract Price of Work:$ ? ��'� <br /> Proposed Use of Building: S fj-tv��. 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 /> . <br /> ASSOCIATED BUILDING PERMIT#(if applicable): �-f,ts�✓' c� •� �- ��}.,� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn Alteration _Repair Type of Project: _New _Addn Aiteration Repair <br /> Fixtu es Lisf of Fixfures Fixfures List of Fixtores Fixfu es ��st of Fixtures Fi�ctu es List of Fixtures <br /> A/C-Air Handling Unifs Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heafer 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 Heafer Ofher: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other. <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•I have reviewed this applicafion and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> currenf federal,state,and local law.The granfing of a permit only authorizes approved work and no deviations therefrom.Deviations musf firsf be aufhorized in writing from the <br /> Building O�cia!before being authorized under any circumsfance.I am the owner,or I am aufhorized by the owner of this properfy fo pertorm the work for which applicafion is made, <br /> and 1 comply with the State Confractors Law 18.27 RCW and 296.200A WAC. <br /> City of Evere(t O�cial Use Only <br /> ` � _. �-- �, � � PERMIT# �I� ��� � � <br /> � <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2096) <br /> � <br />