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PERMIT APPLICATIOI� <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)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> (Blue o,r Black ink'Only Please) ;` ;; ,' PROJECT SITE;INFORMATION <br /> __. . � ._ <br /> PROJECT SITE ADDRESS: q I� S� E%Jp.y`Q.�' t�-lct�Q L� PROPERTY TAX#: �.�j�Lf j)�� <br /> LEGAL for new construction: Short Plat/subdivision ��'°t Lot No. (attach copy of long legal description) <br /> 'CONTACT�NFORMATION <br /> OWNER NAME: E--y � �c �}p�_ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: SIREET Gj�. '�j�/'���' �(.Q.Q�Q; W <br /> CIIY �j .e��"'{' STATE y v � ZIP �Q�..G� <br /> OWNER PHONE: N I�t OWNER EMAIL: N�/-� <br /> CONTRACTOR NAME: (�pY{��c� �r`Q, � �-eyy�,d <br /> CONTRACTOR ADDRESS: srneeT �a„�,p4 S (h�Y2� /� S. d3I� -� <br /> �� i�,e►�t- sTA� wA Z�P �.�� <br /> CONTRACTOR PHONE: 0��� �"�"�-'�CjU ,� CONTRACTOR EMAIL: �r rP-3�(,��5 �}�-W�S .G�� <br /> CONTRACTOR LICENSE#(REQUIRED): 1�.�D Rj�F�j�a.g�.,�ic�, CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):D�U�� <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: K(,�}�1 U'(���(' -�j� CONTACT PHONE: °�Q 19 �''�a.'�'S D� <br /> NL)��+�?e-4�� �i1T�-S ��C�YVtS CONTACT EMAIL: 1.��(�a,�(���(,/'�s S(-�ivv,S.�A <br /> . � . . . , ._ _ <br /> . _ � . <br /> ~ ��� � ,.- ' ' �= Btr1�.DIN6��ER�Ii�I�'APPLICA�ION" : ��. � � � <br /> Existing Use of Building: �pt,��'v1k � -(affi C�,. Contract Price of Work:$ '��� �� <br /> Proposed Use of Building: �p�„� ' —df�Fi C� Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex Multi-Family�of Units: Commercial ❑Industrial <br /> T pe of Project: ❑New ❑Addition ❑Remodel �Re air T.I. ❑Sign Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ��� Sp�n��� T. L.� (�Q���Q, �p� p`,(�,� GIQ,�:�- <br /> �N' �'�G�v�'- i �;,��l,c� . {��ct��e�1�er.� o�d�ao�o�'� <br /> " �;v�, ��� h e�cl s� tJ n �I.�.a��� i� �d��-+��.ie� c a-Q.,c� • <br /> ASSOCIATED BUILDING PERMIT#(if applicable: <br /> MECNANICAL PERMIT APPLICATION PLUMBING PERMIT APPL1CAt10N. ;, :. ' <br /> Type of ProJect: New Addn Alteration Repair Type of Pro)ect: New Addn Alteratian _Repair <br /> #of Lisf of Fixtures #of ��st of Fixtures #of ��st of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fiartures Fixtures <br /> A/C-Air Handlin Units Heat Pump Toilet Backflow Preventer(Inside Bld <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 /> Ran e Hood Water Heater Other. <br /> Exhaust Fan Sink(Service/BadMop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical o Water No.of Heads <br /> ACKNOWLEDGEMENT.•I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comp/y with <br /> current federal,state,and local law.The granting of a permit on/y authorizes approved work and no deviations therefrom.Deviations must first be authorized in wrifing from the <br /> Building O�cia/before being authorized under any circumstance.I am the owner,or/am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett O�cial Use Only <br /> � , n ��Ck.(�L IVDyI�'l�l�-►Y (-I� �j j��o...�l PERMIT# � � <br /> ' � ( - oo� <br /> UVIh, l� vvvvr <br /> Owner/Authorized Agent nature Date �(�n�.�r1�1'� (Revised 9/23/2016J <br /> �) 4v <br />