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PERMIT APPLICATION <br /> BUILDING !MECHANICAL/ PLUMBING /SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320Q CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-6810 � FAX 425-257-8857 �(E)everettepsQeverettwa.gov� vnvw.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE lNFORMATION <br /> PROJECT SITE ADDRESS: { PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lnt Nn. (attach copy�f long legal description) <br /> CONTACT INFORMATION <br /> tJWNER NAME: � �'"" TENANT NAME(If Commercial): <br /> t7WNER MAILING ADDRESS: srkEEr �{� <br /> ;rrv STnrE z�� �, <br /> OiNNER PHONE_ 4WNER EMAIL: <br /> CC3iVTi2ACTOF2 NAME: �„ ` <br /> CONTRACI'QFt ADDRESS: srREEr <br /> cirr �yg{ srn-r= ziH <br /> CONTRRGTf3R PHONE; — CONTRACTQR EMAI�.: . <br /> C4AlFRA�T(?R LICENSE#(R�C2UIRECJ):�,,� '7� CITY OF EVERETT 8tlSI ESS LICENSE#{RE(1t11RED3: �� <br /> PRiMRRY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CO TACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLiCAT10N <br /> Exisfin Use of Buildin : Contract Price of Work:b <br /> �roppse�i Use of Buiidin : Heat Source: Gas �Electric ❑Other <br /> SuiEcling Typ�: ❑SFR-Detached ❑SFR-Attached Du�slex ❑Multi-Famil -#of Units: ❑Commercial ❑Industrial <br /> 7 pe of I'ro ect: ❑New ❑Addition ❑Remodel ❑Re air ❑T.L C�Si n ❑S rinkier ❑Demolition ❑Chan e of Use <br /> DESCRlPTION OF WORK: �U �a,��l � +`-�W��.�q l�_ `, �, <br /> �y.yv� 1 GA TTcw�v <br /> ASSOCla7�t�BUILDING PERMIT#{if a�a licabfe: <br /> MECHANICAL PERMIT APPLICATION PLUM�IN� PERMIT APPLtCAT1ON <br /> Type of Project: _New Addn Alteration Repair Type of Project: _New _Addn _Alteration _Repair <br /> Flxiu es List o/Fixiures F�X u es ��si a/Fixtures Fixtu es List o/Fixtures Fi tu es List of Fixtures <br /> A!C—Air Handlin Units Heat Pump Toilet Backflow Preventer Inside Bld ) <br /> Forced Air S stems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinkin4 Fountain <br /> Water Heater Refrigeration Shower Fioor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes DrVer Hookups Other. Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(ServicelBar/Moo/etc.) Other: <br /> SPRINKLER/SUPPRESSfON SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:1 have reviewed this applicafion and confirm the information confained herern is true and correct. Work done pursuant fo this permit musl compry with <br /> currenf federal,slate,and foca!law. The granting o/a permrt only authorizes app�oved work and no deviations therefrom.Deviations must first be authorized in wnting(rom the <br /> Building O�cial betore being authorrzed under any circumstance I am ihe owner,or I am aulhorized by fhe owner of this ptoperty to perlorm the work for which applica(ion is made, <br /> and I comply wifh Ihe Slafe Contiaciors Law 18 27 RCW and 296.200A WAC. <br /> City of Everetf O�cial Use Only <br /> PERMIT y D�� <br /> OwnertAut ri ed Agent Sign e Date {R�vrsed�;�3Z2L14t51 <br />