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'' II IIIIIIII PERMIT APPLICATION II <br /> BUILDINC.7IIECHANICAL/ PLUMBING /SIGN / UITIINKLER/DEMOLITION <br /> "111.11---i <br /> 4„ CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: //Z4, / ReEfi/ /AA)/ ' As PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ToyLA.,t 40),(77A/4„ L C TENANT NAME(If Commercial): 77$ T iQii /4/j/�,g 1:7— <br /> OWNER MAILING ADDRESS: STREET / _g"-.3 t .4:2A D ,(/g IV <br /> CITY A4(,�{ I tier) STATEeo-A zip 9T.Z.7� <br /> OWNER PHONE: / 1 OWNER EMAIL: <br /> CONTRACTOR NAME, `?�//,S'/%1"17 4 ; cod ctz ,6 c "/ 60,-T <br /> CONTRACTOR ADDRESS: STREET p„;:7,,p 71 <br /> cm, / cyc� /!/i 4j/0p6/ Wg 9e(/ T�7 STATE ZIP <br /> / JCONTRACTOR PHONE: l Z5 y7CONTRACTOR EMAIL:CONTRACTOR LICENSE#(REQUIRED): rclas/05 010 /(r CITY OF EVERETT BUSINESS LICENSE#(REQUIRED 14(1-(-- -lit <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please` Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial 0 Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.l. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <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 /> Chemical or Water I 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 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 /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> V_Z <br /> y <br /> ✓ /J �oie PERMIT# <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />