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PERMIT APPLICATIdN <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 /> '�gfct�b�B�ac�I�r1���ty,Rtease� P[��E�'T'S�'��IN�ORM��IOI�� ��. £ . � - = <br /> PROJECT SITE ADDRESS: �j,l�,/ �(, Z p PROPERTY TAX#: 2 �Q�'�j OO <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> x �$�,'�.���. ;f , �� �,;��0�,'f'E����11�[�ORII�IAT�ON; �`j � ,� <br /> OWNER NAME: � r ( TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReeT Q ♦ � <br /> CITY STATE ZIP /�II Z, <br /> OWNER PHONE: �z.�- S9 ..._ DQ OWNER EMAIL: Gj D� �-- . pM <br /> _ _ <br /> CONTRACTOR NAME, ,�.�-1 � � ____�L/�OI�IS <br /> CONTRACTOR ADDRESS: sTReeT -'O }'� '� <br /> ciTv T j`(' STATE ziP � <br /> CONTRACTOR PHONE: - - CONTRACTOR EMAIL: j� �j �J�f CC�1( <br /> CONTRACTOR LICENSE#(REQUIRED): �T�v �D CITY OF EVERETT BUSINESS LICENSE#(RE ED): C�52132 <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) � <br /> CONTACT NAME: CONTACT PHONE: (f2,5"- _ 2 <br /> �� jl(1�L/�S CONTACT EMAIL: G �S� • ��! . C <br /> � ` BtJItDlN'G'�PERIVIIT APPLICATIQN��;���^s� � `�` � �st� �. ' ' <br /> Existing Use of Building: � � �� Contract Price of Work• � � �, . � �� <br /> Proposed Use of Building: Heat Source: ❑Gas lectric' <br /> Buildin T pe: ❑SFR-Detached ❑SFR-Attached ❑ uplex Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Co���C�GYI OF ��u� TR� 'lIti � <br /> I �)�a��► vhc�nt�w�r�f 5�ri <br /> ASSOCIATED BUILDING PERMIT# if a licable): <br /> �� � � _-� ^�w�� �� � � �� � � <br /> " INEC,�AI��GAL rPERMIT APPLICATIQN'.; �F '� '° } � , �;� PLUMBI;NG PERME'E"�'APPL'ICATfOhI;,; A� � , <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fi�ctures #of Lisi of Fixfures #�f List of Fixtures #of List of Fixtures <br /> Fixfures Fixtures Fixtures Fiutures <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 /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SP.RfNKLER F=SUP,PRESSI,ON SYS,T„EI�IE,,; �����„! <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 thereirom.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 WAC. <br /> _^�""'1 City of Everett Official Use Only <br /> � -- � <br /> -/ j�� l� P IT# �"V �l �O � <br /> l <br /> Owner/Auth zed Agent Signature Date (Revised 9/23/2016) <br /> � � <br /> �_ ���� ��� <br />