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PERMiT APPLICATIOW <br /> BUILDING /MECHANICAL/PLUMBING 1 SIGN /SPRINKLER! DEMOLiTION <br /> ClTY QF EVERE7T PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps�eve� a.gov� www.everettwa.gov(permits <br /> (Blue ar Black Ink Only Ptease) PROJECT SITE INFO ATION`, <br /> PRQJECT SITE ADDRESS:��� � �'�y 4�1 t l.�`L�,� .�„� V���1' �� D PR�PERTY TAX#: <br /> LEGAL for new construc6on: Short Piatlsubdivision Lot�lo. (att�ch copy of long legai desCription) <br /> CONTACTIN�OR <br /> OWNER NAME: �' �y"9 � ��t�„i'ti' TENANT NAME(If Commercial): ��,,�� �..C_'-�r'l <br /> OWNER MAILING ADDRESS: sTRE��� � �- � �Y��1'�,,,�.o� D�..-Z.�--' i✓'�Z. - <br /> (;ITI' ���lJ"C..�"/ � L�' STATE ./�,., 71P ��r��+-�,.d <br /> OWNER PHONE: , ���,? , � .�-�j'�,% OWNER EMA1L: <br /> CONTRACTOR NAME: �JY G�l'� J�`Yl -�' C�t�'�-L�'� � `�-- ���`? ._..t,-� ij]�:.., <br /> CONTRACTOR ADDRESS: srneeT "7�J I� �` ,�L��- �d. � <br /> cmr �/'�.�(.` ��-r �f d � � sTare LC.,.r'G'��t., ziP ���:.:�'���— <br /> CONTRACTOR PHONE: - �-�s��`- �C.�<,�-� CONTRACTOR EMAIL: � (���"y'��'Y`i���Gf '' f.}�'Y�� �.y1�" �\ <br /> CONTRAG70R UCENSE#(REQUIRED):�����'t'Y r��Z5 c�`�t" �.3� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ' ���"�' � ; <br /> . PRIMARY CONTACT: ❑OWNER L�ONTRACTOR ❑OTHER(Piease Specify) <br /> CQNTACT NAME: CONTACT PHONE: ,- ��'. ` <br /> ���} ����v <br /> �_�{,,'i�' {,� �"✓� �• �-�f�.- CONTACTEMAIL: �'1�'v'"�;�5��'1f} �i�G9 � .C����,d'L.L��, <br /> 'BUfLDING PERMIT APPLICATION ' <br /> Existing Use of Building: Contract Price of Work:� �'����: � <br /> Proposed Use of Building: Heat So�rce: ❑Gas ❑�lectric ❑Other' <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ulti-Family-#of Units: �' ❑C�rnmercial ❑industriai <br /> Type of Project: ❑New DAddition ❑Remodel epair ❑T.i. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: r �-- <br /> � ! �-� (..r�� �-�-���C� °�r��,�c�..t_.� v�-���� ����'a��r-�-�_�--, <br /> ASSOCIATED BUILDING PERMIT#(if applicable: <br /> MECHANICAL PERMIT APPLIGATlON PLUMBING PERMIT APPLiCATiON <br /> Type of Project: New _ Addn Alteration _Repair Type of Project: _Newr Addn _Aiteration Repair <br /> #of List of Fixtures #of List of Fixiures #�f LFst of Fixtu�es #of List of Fixfures <br /> Fixtures Fixtures Fi�ctures Fixtures <br /> A!G-Air Handling Units Heat Pump Toiiet Backflow Preventer(inside Bidg} <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 Woad Stove Kitchen Sink&�isposal Grease Trap <br /> Gas Range Ductin Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Ciothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRIlrIKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> , ACKNOWLEDGEMENT:f have reviewed ihis application and coniirm the information confained herein is true and correct.Work done pursuant to this parmit must compJy with <br /> current federal,stata,and local law.The grantrng of a permit only auihorizes approved work and no deviatrons thercafrom.Deviations must frrst be authorized irr wrrling from the <br /> ' Buriding Official before being authonzed under any ci�cumstance.I sm the owner,or 1 am authorized by the owner of this propedy to perform the woik for which application is made, <br /> and 1 compl 'th the State Contracfors Law 18.27 RCW and 296.200A WAC. <br /> /-� City of EvereH O�cial Use Only <br /> 1` �, 1 _ PERM�T� � � _ �CJ <br /> i �i� ��-l� � <br /> Owner/Authorized Agent gnature Date (Revised 9/23/2016J <br /> � <br />