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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 I <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� wHvd.everettwa.gov/perrnits i <br /> PROJECT SITE INFORMATION <br /> PROJ C �'- DD ESS: PROPERTY TAX#: I <br /> �--j-.('i. -!'' /�c� I <br /> LEGAL for new construction' Short F'lat/subdivision Lot No. (attach copy of long legal description) I <br /> i <br /> CONTACT INFORMATION ! <br /> OWNER NAME: ;'��N (_,� . - �., -�,_� TENANT NAME(If Commercial): , <br /> ^ <br /> OWNER MAILINGADDRESS: sTReer (;, ��� �'t�;�i-c t�•.. T�;i�- c�_ <br /> `l�' i <br /> CITY � _ � STATE LJ 3'�'� Z�p � � � _j � <br /> OWNER PHONE: OWNER EMAIL: `c-� f�,� E, `- <br /> ti.t ;� � -.rc- <<� <br /> I <br /> CONTRACTOR NAME: I� , c:�%c: � �-�.:'.i�- <'<_ /c._ Y.�� �- � ;�- � <br /> I <br /> � <br /> CONTRACTOR ADDRESS: sraeEr �;y '/Z --•��,�:�.7: � � � <br /> ciTv � - srnrE '"� zia !� <br /> dC-<t �{' <-✓r' '� a / �. <br /> CONTRACTOR PHONE: � J �- � 7 �/ — j�•• 5 'J CONTRACTOR EMAIL: •� ,L ,�. 1 `::'3� ' ,,�.�� ��, � ,--z � <br /> CONTRACTOR LICENSE#(REQUIRED)X�.�,,,,,�.�� ` �•��; t�.� CITY OF EVERETT BUSWESS LICENSE#(REQUIRE : � ! <br /> PRIMARY CONTACT: NER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: c�r�S _ --� �Y ,_ -� `, :j:j <br /> �y,� CONTACT EMAIL: ! <br /> � <br /> _ � � E <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ ..� ���° <br /> Proposed Use of Building: Heat Source: as ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Dupiex ❑Multi-Family-#of Units -- �Gommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Si n ❑S rinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> '✓��1-r{c�t l j—�_i-�,,��..•� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): , <br /> I' <br /> ' MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION !; <br /> Type of Project: _New _ Addn _Alteration Repair Type of Project: New _Addn _Alteration _Repair i <br /> #of List of Fixtures #�f List of Fixtures �°f List of Fixfures #of List of Fixfures <br /> Fixtures Fixtures Fi�ctures 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 i <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/Mopletc.) Other: <br /> ✓-r ati � �_ '� <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT:I h reviewed this application and confirm the in(ormation contained herein rs true and correct.Work done pursuant to this permit must comply with F <br /> current federal,state,and loc�law.The gra a permit onty authorizes approved v✓ork and no deviations fhere/rom.Deviations musf first be authorized in w��fing from the � <br /> Building O�cial b�fore being authorize nder any ircumstance.I am the owner,or I am authorized by t6e owner of this property to perform the work foi which application rs made, �� <br /> and I compty wjNi the t3fe Contr �rs Law 1827 CW and 296.200A WAC. <br /> Ciry of Everett Official Use Only <br /> � PER l�� ` ��� 4 <br /> C�'-r� - ,� � , � � <br /> O er/AuthorizziJ Agent Signature Date (Revised 10/12/2015) <br /> a <br />