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grr PERMIT APPLICATION <br /> BUILDING / MECHANICAL / PLUMBING /SIGN / SPRINKLER/ 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 /> PROJECT SITE INFORMATION <br /> PROJ V X t) 4DDRV I C 10-r I /z,,e t�. PROPERTY TAX#: <br /> LEGAL for new construction:(Short Plat/subdivision �1P Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: w cLCZ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET j''G oy y " A-ke E • cfzi <br /> .1.,1 A/co 00 p CITY STATE '"-- ZIP V 2703 C, <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: /"l-( S C (,2- W G C-z-Y la-2 <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: -1/4-2,5 35/ O('2/ ' CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> '`j/25 3 / t /Zf CONTACT EMAIL: <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: DNew DAddition ❑Remodel ❑Repair CIT.!. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: , s %. <br /> ed S Q,,,,) ` /4c5-,-,C, I <br /> 2, <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.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 Cy:ctors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 0 7' -2 /2-71 -IS <br /> PERMIT# <br /> Owner • thoriiz:. Age Signature Date (Revised 10/12/2015) 9* <br />