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PERMIT APPLICATIONM <br /> ,,�11/ BUILDING/MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> / CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink;Only Pleasee) „ } PROJECT SITE INFORMATION , 4 <br /> PROJECT SITE ADDRESS: /'3/. cT 1 Pf Z/p.--L, PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: d v,P� G 2(' (7,0,47-1.,z. <br /> TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: -,1 r ",/ , OWNER EMAIL: <br /> CONTRACTOR NAMt ti c (0)04 ' i G(,6, <br /> CONTRACTOR ADDRESS: STREET 2-20.,--k-54.. -,/ks—e <br /> S- /4;),) cITY (ti -1i-) STATE -2... . ZIP <br /> CONTRACTOR PHONEOIC/%S'23J(� CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED)-/uPjG co l CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:4. 3I J f7.-1' <br /> /CAII ( ]e4'ti r1,41:1A / CONTACT EMAIL: <br /> ;;' <br /> BUILDING PERMIT APPLICATION " 4 -1 c c=c_ , <br /> Existing Use of Building: Contract Price of Work:$ c1V'o- <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached -Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ONew ❑Addition *model ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORE �epiel,. d c___ _'t) /,1—e <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 #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump C Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater / Bathtub Urinal <br /> Gas Piping Boiler t Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove J 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:l have reviewed th's 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,•Jf nting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before.:ing authoriz-J nder any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with t • St. e Contra/. Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ,,,A1/11( PERMIT <br /> O(}— <br /> 'wner/Authoriz'i Ag'Tilt Signature Dat: (Revised 5/21/2016) <br />