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PERMIT APPLICATION <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: •' �'_;� 4 ���i� � � �'C , ��✓���• � Ll ROPERTY TAX#: (,�C� ��I��ZF-)�C��L�(,,G)Z <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: f j� l���'k� � 'l �C�,� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReer ���. �'� � �l 6�L�t � ll� <br /> � �/ / Q .(��^{� <br /> CIN V'—l. � � STATE (:�/' ZIP ,(/' <br /> OWNER PHONE: � �� �_; 'L`��j �}' � 1.�� �'� OWNER EMAIL: �t��� 1 l[ t' � t' L-� (� � <br /> CONTRACTOR NAME: `.�� � -� �f;.J%-�l�. <br /> CONTRACTOR ADDRESS: sTREeT <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) � (�r C l � <br /> CONTACT NAME: CONTACT PHONE: �j f� �� j� � j�'js <br /> ���"�� ����`�'L�� '�/��� � CONTACT EMAIL: � � , -, ' <br /> Ga d 2l YI� � �t.� j-L�c� l • �'i¢;.'z� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: , �'�' t � �`U1 " Contract Price of Work: $ � ��� <br /> Proposed Use of Building: i ,��� �+'y-� Heat Source: [�as ❑Electric ❑Other <br /> Building Type: �`SFR-Detached ❑SFR-Attache ❑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 WOf�K: �'��,�>�- � �� ����F��,� /� y,e�,,� <br /> C,��v���-rt-�- t=�i sr . �. �-, y z . <br /> �t� �'7` �A 1�� ��`�� �`1� . I ti�'�I��o� f1 t j��n.�'�7'c�;J , f�✓S�i,� ( c.�n.�.� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> �� n p-c���• <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 #of List of Fixtures #of Lisf of Fixiures #of List of Fixtures <br /> Fixtures Fixtures Fixiures 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 /> Chemical or Water No. of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the informatfon contained herein is true and correct. Work done pursuant to fhis permit must comply with <br /> current federal.state,and/ocal law. The granting of a permit only authonzes approved work and no deviations therefrom Deviations must first be authorized in wnting from the <br /> Building O�cia/be/ore being authorized under any circumstance.1 am the owner.or!am authonzed by the owner of this property to perform the work for which application is made. <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> � _ Z:. -c__��... <br /> ,� PERMIT�t: <br /> ��- j�f- l-�; I� ' � - �� <br /> OwnerlAuthorized Agent Signature Date (Revised 9/23/2016) <br /> i(� <br /> l <br />