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PERMBI"APPLIC�4TIOfri <br /> �IJIL.DINC� / iViECFiP,NICAL/ PLU�fi�IRIG / SI(�IV / SPR9N@jC�ER/ DEI�IOLITION <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� wv✓w.everettwa.gov/permits <br /> (Blue or Blacic In4c Only Please) PROJEC7°SITE ONFOEtMl4TIOP1 <br /> PROJECT SITE ADDRESS:�Z Z C'Z ��.(�LSZ7V� C�.t,"'�_ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> GONTAC`f' INFORMATIORI <br /> OWNER NAME: C�(-�x �(,(,U.)L�l TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReer ��2 . Cl(,�SG`�'l CL(,-`-t <br /> cirr �li�.✓'L� srnrE I.� ziP �`G� ��.=� <br /> OWNER PHONE: L4� �� � ��� l OWNER EMAIL (,l.►�(C,u V� �l►n�" C- L��/(iLCi 1 ' . CC �^ <br /> CONTRACTOR NAME; i����� (�Vl^ 1/�,' �vV� � <br /> CONTRACTOR ADDRESS: sTrzEET P. �, l�i�`� �Z�"�� <br /> CITY C �/�j✓�'�,� STATE �v" ZIP ( ����-c <br /> CONTRACTORPHONE: 2U.( �l�%�3 - ���C3 CONTRACTOREMAIL: S�C—�- ' l`= ��i��-�- C��^'� .��-�i�"�� <br /> CONTRACTOR LICENSE#(REQUIRED): S l �,�I�(, � �;;.� (;1��J CITY OF EVERETT BUSINESS LICENSE#(REQUIR D). ��,p <br /> PRIMARY CONTACT: ❑ OWNER `�I CONTRACTOR ❑ OTHER(Please Specify) � <br /> CONTACT NAME: �t��..�-�� ���� J-(�/� CONTACT PHONE: �(,� ���3 � �r t�(,f <br /> CONTACT EMAIL: �e� ._2'�- � ((,f v��.f, CC' �'h <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: � Contract Price of Work:$ C� �LS� <br /> Proposed Use of B � ing: �j�� �� Heat Source: ❑Gas �lectric ❑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: � :�� .� ) �C�, �i�2 <br /> � <br /> -��"l"��i`�►�� ��'���'rZ%[''s��/1 , �?C��l?-��C;r'l�l -�� �n<<s� �'tyi.��r��� <br /> ASSOCIATED BUILDING P,_ MIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICiAT10N <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fi�ttures ��f List of Fixtures #°f List of Fixtures #°f Lisf of Fixiures <br /> Fixtures Fixtures Fixtures Fixfures <br /> A/C-Air Handling Units Heat Pump ( Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater f 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 /> Z, Exhaust Fan / Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No. of Heads <br /> ACKNOWLEDGEMENT.1 have reviewed this application and confirm the information contained herein is true and correcf. 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 therefrom.Deviations must first be authorized in writing from the <br /> Building Officia!before being authorized under any circumstance. I am the owner,or 1 am authorized by the owner of fhis property to pertorm the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> � 7 City of Everett Official Use Only <br /> ,< � '. PER # ��� � / <br /> -� �. �� _ I �-, <br /> \L,/ / <br /> Owner/Awfh 'ze �cg Signa r ate (Revised 9/23/2016) ,, ➢ <br /> ` j �''. <br /> ('L.�_> %, <br />