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PERMIT APPLICATION <br /> BUILDING/ MECHANICAL/ PLUMBING /SIGN /Sr�R�IVKLER/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: /Zz:'j ,�,�"� ��/•�rc j'Y1c�%/ [�.'�t PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: '-�i�J'e r/ �yr� �/ / LC C TENANT NAME(If Commerciai�: �r n -�� <br /> OWNER MAILING ADDRESS: sTaeeT �{� -� ����t' � L � _Sc;�Cs <br /> arr •�/l V�r sra� �U vP D D 3 7 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: (;j�i;�� � �,rS <br /> CONTRACTOR ADDRESS: srReer � �. ` n 1C 2 � %�G� <br /> �'^��"/'d�?.,j�, cirr srare ziP �'� `I I <br /> CONTRACTOR PHONE: �S.` �=��' Z�,� CONTRACTOR EMAIL: �e�',,i.t �(.� C�c'��:f vviC L'��c: , ,;t — <br /> CONTRACTOR LICENSE#(REQUIRED): ��r`� � � � l`� � Z CIN OF EVERETT BUSINESS LICENSE#{REQUIRED):��� Ej�� <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 1��5-- ��"��`-�Z (� S <br /> � � �. " T CONTACT EMAIL: � '� <br /> E e;� �,,e,> �.�, ; ��t nw<<a r,.; �'�.�� ��e . :� <br /> BUILDING PERMIT APPLICATION <br /> c � <br /> Existin Use of Buildin : Contract Price of Work:a ,��l� � <br /> Pro osed Use of Buildin : Heat Source: ❑Gas ❑Electric ❑Other <br /> Buildin T e: ❑SFR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Famil -#of Units: ❑Commercial ❑Industrial <br /> T e of Pro�ect: ❑New ❑Addition ❑Remodel ❑Re air ❑T.I. ❑Si n ❑Sprinkler ❑Demolition �Chan e of Use <br /> DESCRIPTION OF WORK: <br /> Y`eS�Y�C��� Is�Y`�� �.5� 1�,� GW� � t (�� s�1�1�v <br /> ASSOCIATED BUILDING PERMIT# if a licable : � � l,' <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn _Aiteration Repair Type of Project: New Addn _Alteration Repair <br /> #of List of Fixtures #of List of Fixtures �°f List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handlin Units Heat Pump 7oilet Backfiow Preventer(Inside Bld ) <br /> Forced Air S stems Unit Heater Bathtub Urinal <br /> Gas Pipin Boiler Lavato (Wash Basin) Drinkin Fountain <br /> Water Heater Refri eration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink 8�Disposal Grease Trap <br /> Gas Ran e Ductin Dishwasher Roof Drains <br /> Clothes D er Hooku s Other: Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink Service/Bar/Mo /etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No. of Heads <br /> ACKNOWLEDGEMENT.1 have reviewed this applicaYion 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 only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Olficial before 6eing authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the woric for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everetf Olficial Use ONy <br /> PERM <br /> � - - ��I�y�%��� , �,�� <br /> Owner/Authorized Agent Signature Date (Revised 923/2016) <br />