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PERIVlIT Af'PLICATIO , <br /> �UILDING !MECHANICAL/ PLUMBING 1 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 S17'E IIVFORMA7'10{V <br /> PROJECT SITE ADDRESS: (�����r �;✓�✓'�y�' �'Id�,�� L✓�� �j'3 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivisiorr Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: z_ TENANT NAME(If Commercial): G c�lt• � ��1�1,h �L G <br /> OWNER MAILING AdDRESS: sTReer <br /> CITY " STATE ZIP � <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTORNAME; 1 1`�'f/���G� �� (iT <br /> CONTRACTOR ADDRESS: s-rReer <br /> cirr STATE ziP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):� <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (.d� �- �Z�^ � G� <br /> ��� L'�. L V 4�s CONTACT EMAIL: �cQ�jq�, G C a k� (//�/q.`s1 .�p <br /> BUILDING PERMIT APPLICATI�N <br /> Existing Use of Buiiding: /1/P�c. Contract Price of Work:$ ��� <br /> Proposed Use of Building: �yn,;q �'v�i. Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair .I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> �D✓1�r'� �i a� Gr N1d�0 �l�s�4' � �%t �at h raa�'h <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 Aiteration _Repair <br /> #of List of Fixtures #�f List of Fixfures #of List of Fixtures #°f Lisf of Fixtures <br /> Fixfures Fixfures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backfiow 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 /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•1 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 locai law.The granting of a permit oniy 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 proper(y to perform the work for which application is made, <br /> and 1 comply wifh the State Contractors Law 98.27 RCW and 296.200A WAC. <br /> City of Everett O�cial Use Only <br /> �'IG� l � PER 6 �Q5 '� 2 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) � <br /> � <br />