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PERMIT'APPLICATION <br /> BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERFT f,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 ((E)everetteps@everettwa.gov� ww�.everettwa.gov/permits <br /> (Blue or Black Ink �nly Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:���j�� ' 3,--��i;f °`,�" PROPERTY TAX# ��'�C"� <"`" �°"� '� <br /> LEGAL for new construction: Short PlaUsuhdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME � TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srr�EET � ` r <br /> d �.�- ';�'ti= <br /> CITY f S = j�`� STATF ZIR � ` � <br /> OWNER PHONE: '� �-�j';'1- ��,'�`I OWNER EMAIL: � <br /> CONTRACTOR NAME; (.---�:=. � t'_�;.�; <br /> CONTRACTORADDRESS: sTReer `-i , <br /> CITY �` s��-�r.y+ STATE �W'�,��--�. ZIP � i'� <br /> CONTRACTOR PHONE �'Y%� ,-�•�� `�� '���, � CONTRACTOR EMAIL: _� ��yr �--�����., r' <br /> CONTRACTOR LICENSE#(REQUIRED): � "� � ` �.�� ITY OF EVERETT BUSINESS LICENSE#(REQUIREp); P`t�-�`�� <br /> PRIMARY CONTACT: ❑OWNER C1 CONTRACTOR ❑OTHER(Please Specify) -' <br /> CONTACT NAME: CONTACT PHONE: - -- - <br /> ` " ` ` f,, CONTACT EMAIL -_ rt <br /> �t_ . - . �. ;�. <br /> BUILDING PERMIT APPLICATION <br /> -, __ ' <br /> � '-�'��;<= <br /> Existing Use of Building: x `,N;y'�"?�,^- Contract Price of Work:$ I <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 �1Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: I <br /> k '; ��.� ��. �: ,;i ; ; , , ..,� �, : , <br /> - . _ . V _. � _ , ., � �,/.c,c_� <br /> � <br /> r, <br /> ASSOCIATED BUILDING PERMIT# if applicable): N <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn Aiteration ,�Repair Type of Project: New _Addn _Alteration Repair p <br /> Fia�tures List of Fixtures Fixtu es List ol Fixfures #�� List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer Qnside Bldg) � <br /> t Forced Air Systems Unit Heater Bathtub Urinal ` <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain f <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 Y <br /> Number of Heads <br /> °. <br /> ACKNOWLEDGEMENT.I have reviewed this.application and confirm[he information contained herein is true and correcL Work done pursuant to this permit must comply wrth [ <br /> current federal,stafe,and local law. The grahting o/a permit only authorizes approved work and no deviations therefrom.Deviafions must lirst be authorized in writing trom the k <br /> Building Olficial be(ore being authorized under any circumstance.l am the owner,or I am authorized by the owner of this pioperty(o perlorm the worl<for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.20oA WAC. <br /> Cify o/Everett Official Use Only �; <br /> _; �., PERMIT �^ � — � � <br /> '�� '� %%i'��� � _"3' ! 7 j��i <br /> Owne uthorized Agent Signa 're u.,�,. (Revised 9/23/2016) t <br />