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PERMIT APPLIC <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT ES <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: q O(� .�� ��'1 � PROPERTY TAX#: 2$�I$BI9 B SO� <br /> LEGAL for new construction: Short PlaUsubdivision Lot o. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): I�� GJ�- Cd���i <br /> OWNER MAILING ADDRESS: srReer <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 'vj✓�'L ,S�1I ��Ii , <br /> CONTRACTOR ADDRESS: srREEr 1/SS !' �` <br /> CI7Y S4�� � STATE ZIP <br /> CONTRACTOR PHONE: '� �gZ��J,�O CONTRACTOR EMAIL: Z /� ,f� I? �J/' . �dy � <br /> CONTRACTOR LICENSE#(REQUIRED): �"/���JG(I�/NJ j' CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): O�OQ` <br /> PRIMARY CONTACT: ❑OWNER ONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Za�Ij _ p Z�O 7O O <br /> s�l:V!.' ,✓��l{�/� CONTACT EMAIL: s f B�e /� ,�v/!� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ Q� <br /> Proposed Use of Buildin : Heat Source: ❑Gas �Electric ❑Other <br /> Building Type: ❑5FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. �gn ❑Sprinkfer ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> r�s�.� or+�� n�<r✓ s�r�t.�,�,���r i c c N,�,1�,�!�p �wc si�'pl�nG¢�� <br /> �'/1.e�'✓��e� �1e�,,/G,. �,�iv�ze! 6��i.►�s-�,���-lw�ti e7i��,tdn�f�/� rr��1��/�. <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 Fixiures #of ��st of Fixfures #of List of Fixtures #of List of Fi�rtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handlin Units Heat Pump Toilet Backflow Preventer(Inside Bld ) <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 /> cunent federaf,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.!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 Co tracto Law 8.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ,r PERMIT# � <br /> ��31-�? '� �--C�O�J <br /> Owner/Authorized Ag t S re Date (Revised 9/23/2016) \ <br /> ��L { <br />