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PERMIT APPLICATION <br /> BUILDING /MECHANICAL/ PLUMBING I SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 047-1- 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 ('(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: it 04 ►34j'AVD �- PROPERTY TAX#: pea. c-t pLA�p S l� <br /> LEGAL for new construction: Short Plat/subdivision pa 5f r& PtPap ,, No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Ca%AL Sc 214OTENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2?O'7 C %4 ,'/ 5 V 116 1140 <br /> CITY E v oven-- STATE WA ZIP 9 a2 <br /> OWNER PHONE:42 Si) 2�j2-lj�dp OWNER EMAIL:OAP-/, Q -M2 ' Q SAsratG, Colts <br /> CONTRACTOR NAME: et- c• ILI.0 <br /> CONTRACTOR ADDRESS: STREET <br /> CRY STATE ZIP <br /> CONTRACTOR PHON(4 24) 2S? -taken CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(RE IRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> A A G 412Y ('st oil AY CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: RE--rA(L Contract Price of Work:$ SaDO <br /> Proposed Use of Building: f ETA I L. Heat Source: O'Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family-#of Units: l commercial ❑Industrial <br /> Type of Project: ❑New DAddition Cl emodel DRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> • <br /> rot) etRimlaiyui vim. l l <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 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 au orized 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!comply with the State C- tractors Law 18.27 R and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# 1P) <br /> Own . orize. A.-nt gn. re Date (Revised 9/23/2016) <br />