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�������� <br /> PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ P�UMBING /SIGN /SPRINKLER/CIEMOLITION <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 Bfack Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: `l•�I�i �?I Pf7� PI.,�C� PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach capy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �. (�GN h�/(� TENANT NAME(if Commercial):�� <br /> OWNER MAILING ADDRESS: srReer 2��(v Gl ���i <br /> CITY r/V�T/� STATE Vy� 21P �,� <br /> OWNER PHONE:� OWNER EMAIL:� <br /> CONTRACTOR NAME; �RR�{ ('E14I GNT�S R�jID.�I�C�/�{I� C'Z��IJG" <br /> CONTRACTOR ADDRESS: sraeer �CJ�''� �I Fi �tj� T� <br /> CRY �DMo�ID STATE W� � ZIP (v�7� <br /> CONTRACTOR PHONE: �Z�rj• � • �'7,( CONTRACTOR EMAIL: (n t.°I�Q 1� IA Y �LQI� ��' GIT1'VI <br /> CONTRACTOR LICENSE#(REQUIRED): 1�1RR`t N}Z)���- CITY OF EVERETT BUSINESS LICENSE�f(REQUIRED): O7JSO�"4'� <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Pleasa Speclfy) <br /> CONTACT NAME: CONTACT PHONE: �.Q�- 65�'�Cl�I) <br /> M l� ���i CONTACT EMAIL: he I�dl��QIr vlL�(� �Lt• COYVt <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Buildin : Contract Price of Work:$ 2�I fl�' fla <br /> Pro osed Use of Building: ✓n-yv� � Heat Source; ❑Gas ❑Electric ❑Other <br /> Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> T pe of Project: ❑New ❑Addition .Q�Remodel ❑Repair ❑T.1. ❑Sign ❑Sprinkier ❑Demolltton ❑Change of Use <br /> DESCRIPTION OF WORK: � <br /> t�F ���-,�cM�iJ-r-� �Mbve eX��t-�w� v��v�rv�ctter��,a�r,1 dec,t�i�g► <br /> �n�,tz�.11 hew �iv�nroedl► ur�derlayY►��-a�d Iro�f��g S�ng��s <br /> ASSOCIATED BUILDING PERMIT# if applicable : <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn Alteration _Repalr Type of Project: _New _Addn Alteratlon _Repair <br /> #of ��st of Fixtures #�f Llsi of Flxtures #of Llst of F/xtures #°f List of Fixtures <br /> Fixtures F/xtures Fixfures Fixtures � <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Pi ing Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refri eration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Ftange 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.•I have reviewed fhls appllcatlon and confirm the Informatlon contained hereln Is true and correct.Work done pursuant to th/s permft must comply with <br /> current federal,state,and local law.The granting o/a permlt only authorizes approved work and no devlatlons therefrom.Devlatlons must flrst be aulhorized!n writing Irom the <br /> Bullding Official before being authorized under any clrcumstance.!am the owner,oi 1 am authorized by fhe owner o/thls property to perform the work for whlch appllcatlon!s made, <br /> and I comply with the State ConVactors Law 1827 RCW and 296.200A WAC. <br /> Clty of Everett OHlclal Use Only <br /> PE T# <br /> t�• +�•1-� ��� �-b � <br /> Own /Authorized Agent Stgnature Date (Revised 9/23/2016) <br />