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PERMIT APPLICATIC <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN 1 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 Inlc Oniy Please) PROJECT SITE INFORMATION <br /> PROJECT 51TE ADDRESS: � e�(_�}�,� S� PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: C �/�D�C� /� (.}S��V l� ��� Tl TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReer�j/� 7 C�L� � f � � � <br /> CITI' �V C��� l STATE �fT ZIP [] � D O <br /> OWNER PHONE: �Z� Z3�J - / D/ (P OWNER EMAIL: ��.J � @ -{�� �1 /� � D � <br /> CONTRACTOR NAME: � V��u���. <br /> CONTRACTOR ADDRESS: srReer <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> _ _ _ _ _ _ _ _ _ <br /> PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR ❑OTHER(Please Specify) � e.V 'l .'�- . �f' <br /> CONTACT NAME: CONTACT PHONE: yz� , Z C� � � � "'�,�!�r fJa/(, ,� <br /> ��� � ��i � ���_ CONTACT EMAIL• .i'�s a�,�-t, ,�� ���� '1;� l;, 'J�G <br /> BUILDING PERMIT APPLICATION � <br /> Existing Use of Building: ,�j,'�N'l ,� J u, l�, L-�—..5 Contract Price of Work:$ Z�� �d'O �' <br /> Proposed Use of Building: � ' ��o� ►-�'*'�-� 'V�a +S� Heat Source: Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR- ttached Duplex ❑Multi-Family-#of Units: ❑Comm rcial ❑Industrial <br /> Type of Project: ❑New ❑Addition � � emodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition Change of Use <br /> DESCRIPTION OF WORK: <br /> ,�• / -I-. / <br /> ��-�iv'�1 c,��.� � �C`'wti v"l ui..�i � �Z,—� t—�f" �J..�l-� �t! ��i_� �( `L� <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 List of Fixtures #of List of Fi�ctures #�f List of Fiutures #°f List of Fixfures <br /> Fixfures Fi�ctures Fi�rtures 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 Z Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> 7 Range Hood ter e r Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPItINKLER/�IJP�RESSi�PY �l(ST�IVI <br /> Number of Heads <br /> ACKNOWLEDGEMENT.I have reviewed this applicatron and confirm fhe 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 therefrom.Deviafions must first be authorized in w�iting from the <br /> 8uilding O�cial before being authorized under any circumstance.1 am the owner,or I am authorized 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 Evereft Offrcial Use Onry <br /> � PERMIT# <br /> � �-�.. �z 7 ��' � .► _ ; . �- �� ! <br /> Owner/Authorized Agent Signature ate (Revised 5/20/2016) <br /> �� �•, <br />