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0 PERMIT APPLICATION* <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />OL (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: i' <br />PROPERTY TAX <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />1 <br />OWNER NAME:ZLC TENANT NAME (If Commercial): 1 <br />OWNER MAILING A DRESS: STREET <br />CITY STATE ZIP <br />OWNER PHONE: •- SS <br />OWNER EMAIL: D co ry` <br />CONTRACTOR NAME, -tY?4 <br />CONTRACTOR ADDRESS: Slk <br />CITY STATE J40ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: GI l rl u" I <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(R QUIRED): <br />PRIMARY CONTACT: XOWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />I l (st . t <br />CONTACT PHONE: .2p4o — qq S`5 <br />CONTACT EMAIL: a ao <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: �o <br />Contract Price of W rk: $ �o <br />Proposed Use of Building: <br />I Heat Source: V6as ❑Electric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi -Family-# of Units: 260mmercial ❑Industrial <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair Wfl. []Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: � r i <br />t -� �.' -- 6 d +- � r,'t-� Bt t (' <br />ASSOCIATED BUILDING PERMIT # (if applicable): _ O <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: New Addn _Alteration Repair <br />Type of Project: _New _Addn _Alteration _Repair <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br />A/C -Air Handling Units <br />Heat Pump <br />Toilet <br />Backflow Preventer (Inside Bldg) <br />Forced Air Systems <br />Unit Heater <br />Bathtub <br />Urinal <br />Gas Piping <br />Boiler <br />Lavatory (Wash Basin) <br />Drinking Fountain <br />Water Heater <br />Refrigeration <br />Shower <br />Floor Drain <br />Gas Fireplace <br />Wood Stove <br />Kitchen Sink & Disposal <br />Grease Trap <br />Gas Range <br />Ducting <br />Dishwasher <br />Roof Drains <br />Clothes Dryer Hookups <br />Other: <br />Clothes Washer <br />Medical Gas <br />Range Hood <br />Water Heater <br />Other: <br />Exhaust Fan <br />Sink (Service/Bar/Mop/etc.) <br />Other: <br />SPRINKLER <br />I SUPPRESSION <br />SYSTEM <br />Chemical or Water I <br />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. / am the owner, or / am authorized by the owner of this property to perform the work for which application is made, <br />and l comf with the Sta"Nntractors Law 18.27 RCW and 296.200A WAC. <br />/j Citv of Everett Official Use Onlv <br />61 <br />