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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)everetieps@everettwa.gov� www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: l r, PROPERTY TAX#: �g431pOU�L(00(� <br /> LEGAL for new construction: Short Plat/subdivision <br /> Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �, TENANT NAME{If Commercial): <br /> OWNER MAILING ADDRESS: sTREET <br /> CITY �Q/ STATE '//1 <br /> � ZIP �fr <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: �I O I p ' � <br /> L� <br /> CONTRACTOR ADDRESS: � `�r e�r 'TI� � <br /> C�rv �� �-+� STATE <br /> ZIP <br /> CONTRACTOR PHONE: � CONTRACTOR EMAIL: �( � <br /> CONTRACTOR UCENSE#(REQUIRED): 5� !�� .�� `��f�a" �ITY OF EVERETT BUSINESS LICENSE#�REQUIREDj: i�+/� ���C�,�< I <br /> PRIMARY CONTACT: ❑OWNER [�,CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �!— .��� � j-f' 11 <br /> _ ��"�►V"'\ �� � b <br /> CONTACT EMAIL: ���^� �G1�GIL 1 O��f�,. G�M <br /> BUILDING PERMIT APPLICATION .' <br /> Existing Use of Building: Y'-eSjG(,Q�G�... Contract Price of Work:$ .S"� <br /> Proposed Use of Building: � �f�1 L� Heat Source: �Gas ❑Electric ❑Other <br /> Building Type: SFR-Detached -Attached ❑Duplex ❑Multi-Famil -#of Units: <br /> y ❑Commercial ❑Industrial <br /> T pe of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Si n ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> �l�r� -�v�I-r4-��' . <br /> ASSOCIATED BUILDING PERMIT# if applicable : <br /> MECHANICAL PERMIT APPLICATION PLUMB�NG PERMIT APPLICATION <br /> Type of Project: _New _ Addn _qiteration _Repair Type of Project: New Addn Alteration Repair <br /> #of #of #of <br /> F/xtures List of Fixtures List of Fixtures List of Fixtures #of <br /> Fixiures Fixt�res Fixtures List of Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet <br /> Forced Air Systems Unit Heater Backflow Preventer(Inside Bldg) <br /> Bathtub Urinal <br /> Gas Piping Boiler Lavator Wash Basin <br /> Water Heater y� ) Drinking Fountain <br /> Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Tra <br /> Gas Ran e p <br /> g Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer <br /> Range Hood Medical Gas <br /> Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> /�CKNOWLEDGEMENT:I have ieviewed this application and conlinn the information contained he�ein is true,and correct.Work done pursuant to lhis permit must comply with <br /> current(ederal,sfate,and local law. The granting of a permit only authorizes approved work and no deviations the�e�iom.Deviations rnust first be authorized in writing hom the <br /> Building Official before being authorized under ony circumsfance.I am tho owner,or I am authorized by the owner of this pro�erty to perform fhe wak for which application is made, <br /> and I co with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> � City of Evereft Officia!Use Only <br /> � PERMIT# <br /> � ,�- Z.� ,� (f�.._.._ ' : � �j ,�,_ � � , <br /> 0 r/Authoriz dge ignature ' � � � <br /> Date (Revised 9/23/2016) <br />