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PERMIT APPLICATIO� <br /> BUILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER/DEMOLiTION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everettepsQeverettwa.gov� www.everettwa.gov/permits <br /> �tlu��ir�l�lnk-��nlyPt+�ase�: PR�ECTS�TEI�EORIMF��'10N- ; <br /> PROJECT SITE ADDRESS: (pa{S S � ����tT �� ��I� �, � �PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> �i����i�'��F��/��� <br /> OWNER NAME: `b T NANT NAME(If Commercial): �r- �j <br /> OWNER MAILING ADDRESS: s�Er C� S� �l�.�� <br /> CITY STATE � ZIP f 3 v/ <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: � � � , .� <br /> CONTRACTOR ADDRESS: s-rRe�'r � �� t� �,..Q�` % � <br /> CIT' �i�( e STATE � ZIP �� <br /> CONTRACTOR PHONE: ��-��3 � -�)(l� CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): D I �� �t'1� � ��CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): l ��0�-I <br /> A., .. �.r ..... ... .... .. . .... � .,.,v . ,:., _,.. ..:. ., . . .�.., .,,. �.,,.. . _... ... �.,_.... . ..� .�. . � _:� „ ., <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRAC70R �I'OTHER(Please Specify) ' 1..:�'1'" <br /> CONTACT E: CONTACT PHONE: � �'3 ' .._ c,..��'�- <br /> � � CONTACT EMAIL: �a � ��� <br /> � t ; ,� � , <br /> - � , ry B1J�I�:D��3`��M1'M�`,�"t�'4�G�►"t"1 , <br /> Existin Use of Buildin : Contract Price of Work:$ <br /> Pro osed Use of Buildin : Heat Source: ❑Gas ❑Electric ❑Other <br /> Buiidin Type: ❑SFR-Detached �SFR-Attached ❑Duplex ❑Multi-Famil -#of Units: ❑Commercial ❑Industriai <br /> T e of Pra"ect: ❑New ❑Addition ❑Remodel �Repair ❑T.I. i n ❑S rinkler ODemolition ❑Chan e of Use <br /> DESCRIPTION OF WORK������� �( �� � ���M�/� �-1' _ ,,,, �( <br /> c}- TI�U� / <br /> � ���� �x'-PS <br /> ASSOCIATED BUILDING PERMIT# if a licable: <br /> :;�- � <br /> �AE�HANICA4 P�RM17"ApPL1CAT1�D1�1 ' ' ` ' `;` PLl11111B4MI�PE�IM�"f":APPLI��T�ON <br /> Type of Project: _New _ Addn Aiteration _Repair Type of Project: _New Addn Alteration _Repair <br /> #of �ist of Fixtures #of �,ist af Fixtures #°f List of Fixtures #of Lis!of Fixtures <br /> Fi�ures �xtures Flxtures Fixtures <br /> A/C-Air Handlin Units Heat Pump Toilet Backflow Preventer Inside Bld ) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Pipin Boiler lavatory ash Basin) Drinkin Fountain <br /> Water Heater Refigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Dis�sal Grease Trap <br /> Gas Ran e Ducti Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink(ServicelBarJMop/etc. Other: <br /> �PRIN�:ER�(�U�"PRE$SKON:SY$fiEM :; ..;.: <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:1 have reviewed this application and confrrtn the infom►ation contained herein ls true and conect.Work done pursuant to this permit must comply with <br /> current federal,stafe,and local law.The granting of a peimit only authorizes approved work and no deviat7ons therefrom.Deviations must first be authorized in writing from the <br /> Building O�cial before being authorized under any ci�umstance.I am the owner,or 1 am authorized 6y the owner of this propeily to perform the work for which applicatlon is made, <br /> and I comply wlth the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Ofhcial Use Onty <br /> �/�� /� �� PERMIT#("� �Q�� �� / <br /> ( `J <br /> Owner/Authorized Agent Signat Date (Revised 9/23/2016) ��� <br /> � <br /> _._/ <br />