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PERMIT APPLICATION <br /> BUILDING / iuleCHANICAL / PLUMBING / SIGN / 5F I:INKLER/ 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/permi±s <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ����,��f J��'�'�-G� �� J7-' �t�c�C'` PROPERTY TAX#: �,''�"� ,�('!��'L' � ��U� C�G� <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: :/ � ��n � r� , °y' TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReer � ��>' �C - r �� ti. �✓ <br /> cirv ���i�l�''�� srnrE ��/f`�- ziP � �Z�%� <br /> OWNER PHONE: LI� � �3 �I- 3 �� OWNER EMAIL: I 1�� �' � 1 i�. �I )�'LL E ' /�1 G l� _ �`/11 <br /> CONTRACTOR NAME ,� / � �� �/L-j � .�; �'���' <br /> CONTRACTOR ADDRESS: srREEr � ]� C� ,S" Z C' ,. / .' <br /> CITY f'.�,l� / y) ' � STATE ,�J=�-- ZIP ��'$L L—� <br /> CONTRACTOR PHONE: L"J� 5 " S S'^,�- � S CONTRACTOR EMAIL: j,�G-JS�' , ` � Z i�' �/,?<r/C - �'<`/� <br /> CONTRACTOR LICENSE#{REQUIRED): 7C �' ��1 h� L_ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): � � ��� <br /> PRIMARY CONTACT: ❑ OWNER �CONTRACTOR � OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: G-��, 5 ' S����� I Z�S <br /> -J k} J 7 I L-S 1.'� /S � � �� CONTACT EMAIL: ' � Z r� �" .- ri <br /> L � S l l;1 � I /�/l �l"/ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: '1 t ���(�:�� '� � ' Contract Price of Work: $ � �� /`�'<' �� <br /> Proposed Use of Building: 'Z % � i � � S Heat Source: '�'�s ❑Electric �Other <br /> Building Type: �SFR-Detached C�SFR-Attached ❑Duplex �Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition �emodel �Repair ❑T.I. OSign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ,., �, --c l C <br /> � ������2u� �=��v��iw��- �� t,�r �� � ��-��� �� �5�,''v <br /> L , �� �' � <br /> ASSOCIATED BUILDING P��IT#(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 /> #�f List of Fixtures #of List of Fixfures #�f List of Fixtures #°f 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 writing from the <br /> Building Official before being authorized under any circumstance.1 am ihe owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> P E RA41�Tj#,�� � ��� <br /> j ��, 5 -z� /� w � <br /> O er/Authorized Agent ' nature Date (Revised 10/12/2015) <br /> � I� <br /> E <br />