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PERMIT APPLICATIO <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: 'i�-j�7j "��, � U(� 'p{(.�, /',\'!�' PROPERTY TAX#: i.>O����]?�f/j'�'/`'<:>" <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ��,(�-f;���U,�j,',_� L.���, TENANT NAME If Commercial : �� i'; ' �� '"' -� <br /> I ) >�;�„ 1.�!•,� �.O U! �/ <br /> OWNER MAILING ADDRESS: srReer (�OG OCK��ELL_ /� E. , ,S �L'7 <br /> CI1Y �—�'��r�,E, STATE � ZIP I Z._U <br /> OWNER PHONE: �-{2�. 3 d'�. �y��`j OWNER EMAIL:"$�'�.NF-4'-:=�. �1`!Ef`SC�? SNC�C�C:. u1=C�� <br /> CONTRACTOR NAME: ��F{-U �� L�H <br /> CONTRACTOR ADDRESS: srrzeer <br /> C I i Y STATE ZIP <br /> CONTRACTOR PHONE: �-{Z� 3`��.�o�`� CONTRACTOR EMAIL: L;r=�'._,�����E'-l%, ��'E�� `C?SNO C.G, Or?�;j <br /> CONTRACTOR LICENS�#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR '�OTHER Please S ecif " _ r{"�)c�t�`;t=.. <br /> � p Y). L° { <br /> CONTACT NAME: V� ���� CONTACT PHONE: C,t-LC� 3�� ��{`( <br /> CONTACT EMAIL '-',E_.t' �i�1�.++=-1-�'. ����'tE..��� `' ��>1�4�'�, i_C�. i�l�Ci+ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ;�-���,,�, �=n��L,� Contract Price of Work: $ �' u�. �J"' <br /> Proposed Use of Building: � ��� ��L�L� Heat Source: �Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial UJndustrial <br /> Type of Project: ❑New ❑Addition ❑Remodel b. epair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:. , r_ .��`� � �.��_�. <br /> {,�--�:�'C_AC_E� F=_?;l'�tn.uS' , <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 List of Fixtures #of 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 /> l Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No.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 theref�om.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumsfance.1 am the owner,or 1 am authorized by the owner of this p�operty to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> ,�r��r�„�.�.. ��. �_�; ��'Y1 �1 � � - � <br /> Owner/Authoriz d Agent Signature Date (Revised 9/23/2016) � <br /> , �Z <br />