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PERMfT APPLICATION ! <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVER�TT,WA 98201 ' <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits , <br /> PROJECT S17`E INFORMATION I <br /> �ROJECT S1TE ADQRESS: PROPERTY TAX#: , <br /> LEGAL for new construction: Short Plat/subdivision _ Lot No. _ (attach copy of lony legal description) <br /> CONTACT INFORMATION <br /> ., � <br /> OWNER NAME: TENANT NAME(If Commercial): r ' �� ,% ' � t <br /> OWNER MAILING ADDRESS: srReFr <br /> cirv srnTE ziP <br /> � <br /> OWNER PHONE: OWNER EMAIL: ; <br /> TRACTOR NAME: � ��a �i C <br /> CONTRACTOR ADDRESS: sT�teer ' <br /> i <br /> � <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: �C�('1"'1' i •� �1�C~- <br /> CONTRACTOR LICENSE#(REQUIRED): 1' CIN OF EVERETT BUSIN S LICENSE#(REQUIRED):� D S Z <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: ` CONTACT PHONE: � � - 2� �� �G� <br /> \�-.�'1':j�! CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ �f� U ' � <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <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 ❑�emolition ❑Change of Use <br /> � DESCRIPTION OF WORK: , ' ^� ,- n ,,,�� / <br /> ��/I���q � c��\E�� �(.+�. W/�/ t h 'I'��' �/�� <br /> J <br /> � �, <br /> ASSOCIATED BUILDING PERMIT#(if applicable): � "`Or ' <br /> i <br /> MECHANICAL PERMIT APPLICATION LUMBING PERMIT APPLICATION ; <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: New _Addn _Alteration _Repair <br /> #of List of Fixtures #�f Lrst of Fixtures ��f List of Fixfures #°{ List of Fixtures <br /> Fixiures 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 k <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 /> �xhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads <br /> u <br /> ACKNOWLEDGEMENT.1 have reviewed tiiis application and confirm the informafion confained herein is true and correct.Work daie pursuant to this permit musf comply with <br /> 'li <br /> current(ederal,state,and local law.The g�anting of a permit only authorizes approved work and no deviations theref�om.Deviations must first be authonzed in writing f�om the <br /> Building Official before being authorized under any circumstance.!am the owner,or I am authorized by the owner of this property to perfo�m the work for which application is made, i; <br /> and I comply wifh the�tat Contracfors Law 1 B.27 RCW and 296.200/1 WAC. <br /> I City of Evereft Oflicial Use Only = <br /> �� --_— � � '� PERMIT <br /> � <br /> /' - _� �I , � �� � � � �� o �� � <br /> r/A h�ed A ent ' nature Date (Revised 1 /12/2p15) ± <br /> � <br />