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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 On1y,Please) uf pROJECT SIT'E INFORMATION <br /> PROJECT SITE ADDRESS: %'�H 1 J ,�VEa�(s�2��'N L✓Ay S PROPERTY TAX#:,[Sl(J L1Z,L(C�O Z Q3)OO <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:S'� KC�lN �151�6--�I� 1�1V£'S=�5 TENANT NAME(If Commercial): I�L�I N j-lON <br /> OWNER MAILING ADDRESS: srReeT � �Q <br /> CITY ���Q,E� STATE i/1�Jr'O ZIP �� <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME; Cf��, ��2T'SOd�J S�6�I SERV�� <br /> CONTRACTOR ADDRESS: s-rReer �"jZ I,Z�M6, �T E <br /> CITY Ty C STATE �+'y ZIP <br /> CONTRACTOR PHONE:ZCj 3— -r'j �—p S 2 CONTRACTOR EMAIL: $S � J e (,'BLt/t <br /> CONTRACTOR LICENSE#(REQUIRED): Vj„ �' LJ� ,6 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):(�S36g S <br /> PRIMARY CONTACT: ❑OWNER ,C�CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NA�M/E: CONTACT PHONE: �S 3�' S��-'O?S Z <br /> �A�VS VpS$�� CONTACTEMAIL: C'$SP�12,yy��-�-5 y�/'' <br /> ..,_ <br /> BUILDING.PERMIT APPLICATION <br /> Existing Use of Buildin : Contract Price of Work:$ �:�� �-��� `0 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Buildin Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: �Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. f�ISign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: R���,4C� E��S�J/'uG I�Yl1Jl�J 5/G/�/ I�UI%P-� ^f�'u1 SI�� <br /> Us► x.�G �x 1 s-r�eu Gl �oo-t'�ti G <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 #�f List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fiutures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <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 Medicat Gas <br /> Range 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.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.I am the owner,or I 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 W,4C. <br /> City of Evereft Official Use Only <br /> PERMIT# <br /> ,.�d.�ti� �l9'�2017 ��� ��' �� <br /> •6 <br /> Owner/Authorized Agent Signature Da e �— (Revised 9/23/2016) 1 �,, <br /> ,��Z <br />