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PERMIT'APPLICATIf <br /> �UILDING / MECHANICAL I 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 Anly Rlease) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: I�p �5 ✓l� +' '�' PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �G�•t�r 1�-- (� ,�� \f�E�'1��1'l TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReer I � �� Ll u� �- � <br /> CITY ��-�V`C..'�" � ST,'TE (�� ZIP �`�� <br /> OWNER PHONE: � C,� �, ��j r� ��� OWNER EMAIL: ti/�- <br /> � <br /> CONTRACTOR NAME; '�(� �p��-�✓l ` <br /> CONTRACTOR ADDRESS: srReer - I • p� O �'�� I w�'� �,=p <br /> CITY � T t t STATE UJ''1 ZIP ��V l ( <br /> �, <br /> CONTRACTORPHONE: � � l� CONTRACTOREMAIL: SCL�-,-�� '�(',l��t- ��`� <br /> CONTRACTOR LICENSE#(REQUIRED): '�tX-��'�f'1 � l �� CI1Y OF EVERETT BUSINESS LICENSE#(REQUI ED): � � <br /> PRIMARY CONTACT: ❑OWNER �ONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: j�-t�"" ����'� CONTACT PHONE: ��� (..��� � C+: ��7 <br /> CONTACT EMAIL: SCC't"I- �L�-- {'C9u����" • �� ✓�` <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ ��� �I�-'- � .. C�C� <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. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: f-�.V�'�('�VGt I �� �y� �Q Jz� O� 7j'-��G'� CIti1� �1��'t� �' �0✓` C3�- }.«vlJ <br /> <<�,�„��,i��- �rC� [.�l`1 �'� �� 5-��-�.-�- cQ���si-�-.r <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 Lisf of Fi�ctures #�f List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixfures <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 /> SPRSl�I6(d.E63/Sl1PP12E��s�Ad �V�7'EIVI <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 local law. The granting of a permit only authorizes approved work and no deviations fherefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.I am the owner,or/am authorized by the owner of firis property to perform the work for which application is made, <br /> and I comply wit State Contractqrs Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> �i/ � ���'—� � PE�T \��� �� <br /> � " - <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />