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grr PERMIT APPLICATION <br /> BUILDING ECHANICAL/ PLUMBING I SIGN / INKLER/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 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJ T SIT DRBS,S; PROPERTY TAX#: <br /> 3 uo �L �Z CZ Avec. 004"2)Loci:1- 1'2-0"7-0C) <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: \2w 0,::"\-- VAU( -, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ul..()v PL Sc <br /> CITY \S(2-c-T7 STATE \„Li AZIP CYB`o <br /> OWNER PHONE: 41.5 530 7713 OWNER EMAIL: N LI-LOW L\V\(-, nn(�I( f ASA), (.-UM <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: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> O <br /> Existing Use of Building: 5� Contract Price of Work:$ V GSI), <br /> Proposed Use of Building: 5/kM`ru Heat Source: ❑Gas ❑Electric ['Other <br /> Building Type: 'SFR-Detached ❑SFR-Attached ['Duplex ❑Multi-Family-ft of Units: _ ['Commercial ['Industrial <br /> Type of Project ❑New ['Addition ['Remodel ['Repair On. ❑Sign ❑Sprinkler El 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 /> Fixtures List of Fixtures hof List of Fixtures Fi> ►es List of Fixtures Fix#torfes List of Fixtures <br /> A/C—Air Handling Units Heat Pump j Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater I Bathtub Urinal <br /> Gas Piping Boiler ( Lavatory(Wash Basin) Drinking Fountain <br /> I 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 /> 1 Range Hood Xate[ljoater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> INumber 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!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 /> (gala • "IxS I I RM <br /> s PEWIT# t / nog,' <br /> Xl <br /> Owner/Authorize.A.: t Si� ature Date (Revised 10/i�/2b15) <br />