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0 PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN / S RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> OL (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: PROPERTY TAX#: Sr.C� (' �- <br /> 301L3c SE E e m&cj u-) ; a'X J J f <br /> LEGAL for new construction. Short Plat/subdivision f Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: —i ree 2 Lt ze,- ` TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY 5 '-� - STATE ZIPi� <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME <br /> CONTRACTOR ADDRESS: STREETIQO I-'i 16� &16A-,;.V1 `, <br /> CITY P t:�'1 STATE .>� ZIP <br /> CONTRACTOR PHONE: ' ? �;J/ - �jt CONTRACTOR EMAIL: Loc• t- C 7� :- `� c' I <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)j7 2- <br /> PRIMARY <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: P-e-4-rti' Contract Price of Work: $ 7 cw <br /> Proposed Use of Building. t 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.l. WSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: c <br /> ►15�E� �-� �►�� :�, �.t �'.IY'x n Ire� 1 lc�-r ��jn cl + � 14�.J S <br /> `Kj.LX: I z I��� <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 /> 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.1 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.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> aqd I compl th the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> yr — Z, <br /> PERMIT# <br /> 4 <br /> Owne�lAu ik4d A e Signa Date (Revised 10/12/2015) <br />