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PERMIT APPLICATION <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 or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: � ,��� _� `�� ;.�c`✓:� (�'Lt�,(� '!i � � PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ��'!,°y�`,`� �l-;;;c � �,' L- -C., TENANT NAME(If Commercial): ����,��- �� <br /> OWNER MAILING ADDRESS: snzeET � � � r <br /> �"S C' 1�lr�% ��c+�l C� 'c�,,;'k��X` <br /> i <br /> CITY ��'�'y� ��6'f(' STATE � ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> .� <br /> CONTRACTOR NAME: � � �;�,�,.i �'�L�'-�c� <br /> CONTRACTOR ADDRESS: sTaeer (,) , / � f,;�:-}I�-II ' 1��f�,,tT" �-�.✓ . � <br /> CITY �vl j!` _y���� STATE l�'-�f'1 ZIP I 1� !T`� <br /> CONTRACTOR PHONE: �� :��'� �"Sc> -`�1�[3 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED):Ij�> ( �j�l. `� �J� � F� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): �S�� <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ,�I OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:y�j -_�S - �j-�"� 5 <br /> �y-��, �� CONTACT EMAIL: �,�v C'' e�� � :�-v'[�� � �Gv�'� <br /> BUILDING PERMIT APPLICATI N <br /> Existing Use of Building: Contract Price of Work:$ ���'�� <br /> Proposed Use of Building: 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. .�1Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: �, <br /> , ,� <br /> :�,t:�; �I�;+r r.�� ���`" �,�i� �.U,�•.,�uz-� � 5 <br /> � 1�-1�; �;=x <br /> ASSOCIATED BUILDING PERMIT# if applicable : <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn Alteration _Repair Type of Project: _New _Addn _Alteration Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtuies Fixtures Fixtures <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&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/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or 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 comply with <br /> current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviafions must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.1 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 with the Sta ontractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> j � f t% PERMIT# <br /> �' � �� �� + 'L� r C.-_ <br /> / �'� �e' � �> � i,� • �.��✓ <br /> Owner/Autho ' Agent nat Dat (Revised 9/23/2016) <br /> � '�� <br />