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PERMIT APPLICATIC:= <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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: (���� ��� �i��t,, ��'�L� ' `C'����Z�f � ��%' ROPERTY TAX#: ��J� �I U �`���G�� � <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: '��--Jf' ��� � ��� �" �= TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReeT 7�a--Z- � �l`�"�� Z�\�'_ % I �.-.' <br /> CITY ��C �Jl.�C�-��' STATE ' ZIP ����-'�-�l - <br /> OWNER PHONE: � • �-t'J�. ��� OWNER EMAIL: �(� F-� � cti! L Z¢' �2��==';.�� �_ �-��-z <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: sTReer <br /> CITY 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: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: �%/�'��:,��y� �- Contract Price of Work:$ 'C'� <br /> Proposed Use of Building: �_�. -��'1 G�{._�n�- � r= � Heat Source: ❑Gas ❑Electric ❑Other <br /> Building T pe: FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition emodel epair ❑T.I. ❑Sign ❑Sprinkler emolition ❑Change of Use <br /> DESCRIPTION OF WORK: � p- � �^�,\ i <br /> �p}�C,�� ��.t LM�"'1 �/L�i�N��ti-('7� �/Lt��l.�,� .r-.j�� i�V <br /> l� i <br /> I (,' <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 List of Fixtu�es #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixiures <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 <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.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 loca!law. The granting of a permit only authonzes approved work and no deviations therefrom.Deviations must first be authorized in wrding from the <br /> Building Official before b ing 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 St Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> '� �� ) (�' �2����� P MIT# <br /> � D <br /> Owner/Aut r en � ignature Date (Revised 9/23/2016) <br />