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PERMIT APPLICATION <br /> BUIL.DING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/DEMOLITION : <br /> CI I Y OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 , <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� wwvd.everettwa.gov/permits , <br /> PROJECT 31TE INFORMATION i <br /> PROJECT SITE ADDRESS: " , _, - � PROPERTY TAX#: � <br /> � c� ��;�L� � %�/" , <br /> LEGAL for new construction: Short Platlsubdivision Lot No. (attach copy of Iong legal description) <br /> i <br /> CONTAGT INFORMATION <br /> OWNER NAME: �/�(,- /��f-= " C '�.-� �/ ENANT NAME(If Commercial): j - ��� ��Gf%�'�� ' <br /> � <br /> OWNER MAILING ADDRESS: srReer � <br /> cin srnTe � ' ziP i <br /> i <br /> OWNER PHONE: OWNER EMAIL• <br /> CONTRACTOR NAME: �G/ � � � ,�'lJ%�I _ 'G' ? � �Z,�' � I <br /> CONTRACTOR ADDRESS: sTaeer z%G� % l �� �-� 'ljL/ C- � �, Cj <br /> i <br /> CITY ij,�,J�l."> >� STATE �� �- ZIP C� � )� <br /> CONTRACTOR PHONE: 2_� � i_.(G CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): C � CIN OF EVERETT BUSINESS LICENSE#(REQUIRED):��� � <br /> PRIMARY CONTACT: `�OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 'z.�^i �, �G,-y�j �� � "- <br /> ���� � ,/� �-'�t.� CONTACT EMAIL: <br /> � ' <br /> � <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Buiiding: Contract Price of Work:$ ' -._r ` <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other i <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Si n ❑S rinkler ❑Demolition ❑Change of Use <br /> DESCRIP710N OF WORK: <br /> �.� �f-� �� �����-� �o�,J�� �t i,�l �f <br /> � <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ' <br /> � <br /> f <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 Fixtures #�f List of Fixtures #of List of Fixtures #°f List of Fixtures <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 <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 /> Number of Heads <br /> ACKNOWLEDGEMENT I have reviewed this application and r.onfirm the informafion contained herein is t�ue and corm,ct.Work done pursuant to this permit must comply with <br /> current federal,stafe,and local law.The granting o� it only authorizes approved work and no deviations therefrom.Deviations must first be authorized in w�'rfing from the <br /> Building Olficial before being authorized u�der aqym umstance.I am the owner,or 1 am authorized by the oumer of this property to perlorm the work for which application is made, <br /> and I com he State Contrar ts Law,y9;27' CW and 296.200l1 WFlC. <br /> �' CityofEverett O(ficial Use Only <br /> � - PERMIT# l -• <br /> �' i `/, ", C_% �l /� �I/I l ; s� '� `i �,i <br /> wner/Author¢ed Ag�nt Signature� Date (Revised 10/12/2095), <br /> / <br />