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PERMIT APPLICATI(��: <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)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: " �j-jj< <? L� PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: � � TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s-rReer c n L> - � � //�. <br /> CITY v STATE ZIP �� <br /> OWNER PHONE: ,3�j'd - 7 3� � Q �,/ '� OWNER EMAIL: <<-l��sT�r S� �'� /n,9/L- , ��M <br /> CONTRACTOR NAME: � <br /> CONTRACTOR ADDRESS: sTReET <br /> CITY STATE 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) <br /> CONTACT NAME: � CONTACT PHONE: -��'p_- � -� � ._ <br /> . � CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <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 ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ,;'�V s�i� �.-,� �rf�� r' i uC3 G/U 5�/�_b' <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of Lisf of Fixfures #�f List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fi�rtures Fi�ctures 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. Tfre granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing f�om the <br /> Building Official before being authorized under any circumstance. I am the owner,or 1 am authorized by the owner of this property to perform the work fo�which application is made, <br /> and/comp/y with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> %����.,��-- = �-/� --/� � I �0�� ���� <br /> Owner/Authorized Agent Signature Date (Revised 5/20/2016J <br />