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PERMIT APPLICATIO4. <br />BUILDING ECHANICAL / PLUMBING / SIGN FRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVI <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />PROJECT SITE INFORMATION .; <br />PROJECT SITE ADDRESS: ew <br />PROPERTY TAX <br />LEGAL for new construction: Short Plat/subdivision larsrloot V lmw ikon-Vo Qr Lot No.0(attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: L Me, A 1-1 TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET V,4CJob `LNAV,, W <br />CITY STATE p� ZIP GJ6 QZ{b <br />OWNER PHONE: <br />1OWNER EMAIL: L p <br />CONTRACTOR NAME: <br />CONTRACTOR ADDRESS: STREET 5AVEIJ <br />CITY STATE ZIP <br />L1,7CONTRACTOR PHONE: cc -- "' � <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): ®TC� <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR 5 OTHER (Please Specify) <br />CONTACT NAME: a/ &V 0 11\ *r 10 <br />v� �yu{Jg4c- - <br />CONTACT PHONE: ZS •• Z U1aLp <br />CONTACT EMAIL: <br />BUILDING `PERMIT APPLICATION <br />Existing Use of Building: <br />Contract Price of Work: $ -456, 060 <br />Proposed Use of Building: S'F9, <br />Heat Source: []Gas ❑Electric ❑Other <br />Building Type: RSFR-Detached ❑SFR-Attached []Duplex []Multi -Family-# of Units: ❑Commercial ❑Industrial <br />Type of Project: lirNew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition []Change of Use <br />DESCRIPTION OF WORK: New �25-& `I 1p� <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />PLUMBING PERMIT APPLICATION - :, <br />MECHANICALPERM' IT APPLICATION, ` <br />Type of Project: &-New _ Addn _Alteration _Repair <br />Type of Project: )C 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 />1 <br />Heat Pump <br />S <br />Toilet <br />Backflow Preventer (Inside Bldg) <br />Forced Air Systems <br />Unit Heater <br />2 <br />Bathtub <br />Urinal <br />I <br />Gas Piping <br />Boiler <br />5 <br />Lavatory (Wash Basin) <br />Drinking Fountain <br />Water Heater <br />Refrigeration <br />Z <br />Shower <br />Floor Drain <br />\ <br />Gas Fireplace <br />Wood Stove <br />I <br />Kitchen Sink & Disposal <br />Grease Trap <br />Gas Range <br />Ducting <br />2. <br />Dishwasher <br />I <br />Roof Drains <br />1 <br />Clothes Dryer Hookups <br />Other: <br />I <br />Clothes Washer <br />Medical Gas <br />Range Hood <br />I <br />Water Heater <br />Other: <br />Exhaust Fan <br />I <br />Sink (Service/Bar/Mop/eta) <br />Other: <br />SPRINKLER <br />/.SUPPRESSION <br />,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 Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />C 1�C)3- 0 <br />(Revised 1011212015) <br />