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PERMIT APPLICATIO� <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> Ey 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� wv�nv.everettwa.gov/permits <br /> PROJECT SITE INFORMATION _ <br /> PROJECT SITE ADDRESS:�`Z��4��. ',f d� PROPERTY TAX#: OD��(�OD(�O�-�� <br /> [.N �J <br /> LEGAL for new construction: Short PlaVsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION ' <br /> OWNER NAME: J 0 P� � ��(r TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREeT �(�1is �1^142�j�e (,/� <br /> CITY ������ STATE W� ZIP 9��" � <br /> OWNERPHONE: ZQG— �IZ ��jS �jq OWNEREMAIL: ,J�j�1pl-tF}[�-�.I.�/�v=�`(�GM��L��� <br /> CONTRACTORNAME: �-A�Ff D '{ �j/�S� YSZ�G/Kr C. � �� AG <br /> CONTRACTOR ADDRESS: srREEr � S�°'F--� ��1� N�. � S <br /> CITI' /�-�{N l�� /`� STATE Z�P �Z <br /> CONTRACTORPHONE: �yQ � 5 �- {�qQZ CONTRACTOREMAIL: STI�� VZA�N�����5-C''M <br /> CONTRACTOR LICENSE#(REQUIRED): �R�i, J��Q�I�-�� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):���Z� <br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR �OTHER(Please Specify) ��S'I <br /> CONTACT NAME: '�S S(G�} CONTACT PHONE: �(' _ 7�S � � <br /> CONTACTEMAIL: S�� F� aGJ (Li�iN�nA`(�S � �-��- <br /> ' BUILDING'PERMIT APPLIGATION <br /> Existing Use of Building: �.('yS( F ��'L Contract Price of Work:$ 0� <br /> Proposed Use of Building: Heat Source: ❑Gas �Electric ❑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 ❑Chan e of Use <br /> DESCRIPTION OF WORK: � <br /> F0�ND P't c a^( w t�.l f'�€ 1.�f'l£� i� 4,(�,- C 9 z�(� 4� �c-4� t�"us <br /> JS�r-�►� � �v S�-t P��R- 5�,��.,-N�- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PWMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn Alteration Repair Type of Project: New _Addn _Alteration _Repair <br /> #of List of Fixtures #�f List of Fixtures ��f List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures 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 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 /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT. I have reviewed this application and confirm the 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.Deviations must first be authorized in wiiting from the <br /> Building Official before being authorized under any circumstance.l am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> ard/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> � PERMIT# -� <br /> . � -� � I ' � � <br /> Owner/Authoriz ent S nature Date (Revised 10/12/2015) � � �1 '—� <br /> /� <br /> ` � l � ��� L <br />