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I III 41477. PERMIT APPLICATION IIIIII <br /> BUILDINAIECHANICAL/ PLUMBING/SIGN I LPRINKLER I DEMOLITION <br /> 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: 2-0IS $r PROPERTY TAX#:005524/O?Z.b08O2.... <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: )7(c.lr._ BRt NO LE" TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 17(o2A OS? 'D• <br /> CITY A 1-1136-TDI STATE WA' ZIP '78223 <br /> OWNER PHONE: 2_O Co•g 20 • $wt j OWNER EMAIL- - riCk®e vv,sploWtb rinytic • CO rt'1 <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: - <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: titOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 20,6 •Tao- $OO° <br /> egA :L)N D LE CONTACT EMAIL: <br /> G'eciertGktEaSkwtOAdSOUwibt+ri9 1 l C . CDM <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <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 @Remodel @Repair OT.I. @Sign @Sprinkler @Demolition @Change of Use <br /> DESCRIPTION OF WORK: '(1 0 Ce s ere- <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 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 /> PERfv� 1OLC f O\ ' <br /> ner/Authorized Agent Signature Date (Revised 9/23/2016) <br />