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Olen- 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 /> (Blue or Black Ink Only Please) ` PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 33 l 3 o 13,Ks i4 1)f PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: y3.rN3�✓ (D p,/' TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: hl 4-4 i eo✓LS)r�. 1 H --.r, <br /> CONTRACTOR ADDRESS: STREET 1(,Ll/A 10 5 /Jami, J� J( �, £ [ q�/ <br /> CITY L,-V(,.0 f•-.V'�;,.,. STATE V+�/ i ZIP / 8•Z 17 <br /> CONTRACTOR PHONE: V2 j 93 5_ ( 9 1CONTRACTOR EMAIL: 4/11i AG�1ii Ieb•-d,5?-y..,t,1 d"�.l°g" pde.�I Co <br /> CONTRACTOR LICENSE#(REQUIRED): Miff/7-(e...4(47/al-C. CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ✓. , / <br /> PRIMARY CONTACT: 0 OWNER N CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> I <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ •"7 j OO <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project ❑New DAddition ❑Remodel ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> e .came s ei2 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 0t1oe2--0(0 <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 q 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 /> i Water Heater Refrigeration Shower Floor Drain <br /> I Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> % Gas Range I Ducting Dishwasher Roof Drains <br /> I Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> 1 Range Hood Water Heater Other: <br /> b Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water 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,.st ,an. al 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 thorized under any circumstance.I am the owner,or lam authorized by the owner of this property to perform the work for which application is made, <br /> and I co iply with the State Co ractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> b/zi/ <br /> Ower/Aut iz-• gent Signature e (Revised 9/23/2096) <br />