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PERMIT APPLICATIG <br /> BUILDING / (ViECHANICAL/ PLUMBING /SIGN 1 SPRINKLER/ DEMOLITIOfV <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 INFOItMAT10N <br /> PROJECT SITE ADDRESS: f , �,�� S� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �V�0�C� � �-S f Ov�j p��i �I TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReeT�j/� 7 C�L.� f � v � <br /> �,n �����n- STATE �,✓�- Z�P 8 z o 0 <br /> OWNEF2 PHONE: �Z� Z3�' � �I D/ (p OWNER EMAIL: �p.I � � -��O d'L /�- � D � <br /> CONTRACTOR NAME, Y� VL) ���. <br /> CONTRACTOR ADDRESS: srREeT <br /> cirv srnre 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) �--s e� '� �- • o f' <br /> CONTACT NAME: CONTACT PHONE: yZ�' � Z Cd /�� .-'�� �'��i,,T CI rAI L ' <br /> �--lT�--�� 9"� , <br /> � ��'�� CONTACT EMAIL: ,i'���� ^ � � il�,�';, J!�G <br /> BUILDING PERMIT APPLICATION `� <br /> Existing Use of Building: °,�j{�c�`'l s^1 c�ui �-� C�� Contract Price of Work:$ z�� d�'C � <br /> Proposed Use of Building: � ' �-�S�� ti,�-,y� {I�° �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 /> � � <br /> �='�-�.�,�,���,e.�(.._ ��-�,��,�� C� �-�,� .L.,� �-�, �.�� �1.�� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn Aiteration _Repair Type of Project: _New Addn _Alteration Repair <br /> #of List of Fixtures #�f Lisf of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixfures Fixtures <br /> A/C—Air Handling Unifs 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 /> �, Range Hood ter e r Other: <br /> � Exhaust Fan Sink(Service/ ar/Mop/etc.) Other: <br /> SPRINKLER/SUI�PFtESSiOPI S1fS7'ENi <br /> Number of Heads <br /> ACKNOWLEDGEMENT.�I have revrewed thrs applicatron and confirm the information contained he�ein rs true and correct.Work done pursuant to this permit must comply with <br /> currenf federal,state,and local/aw. The granting of a permit on/y authorizes approved work and no deviations therefrom.Deviafions must first be aufhorized in writing from the <br /> Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which applicafron is made, <br /> and!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Cify of Everett Offcial Use Only <br /> � PERMIT# <br /> -�,� ��.�� ,/' (� '.�� � ;; 7 �� � - <br /> Owner/Authorized Agent Signature ate (Revised 5/20/2096) <br /> f� <br />