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! 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: 7fZj G ,&t <br />PROPERTY TAX #: <br />LEGAL for new construction: Short Plattsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: L:6AW6LYi4 TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET "7 j kJ <br />CITY W% STATE ZIP <br />OWNER PHONE: (/2 7 <br />OWNER EMAIL:Ye Z I ryt� <br />CONTRACTOR NAME; <br />CONTRACTOR ADDRESS: STREET <br />CITY STATE ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />CONTACT PHONE: L I✓ <br />CONTACT EMAIL: rnq I <br />BUILDING PERMIT APPLICATION Jl tcc V-,e�CaOTIU�i <br />Existing Use of Building: `�' �� <br />Contract Price of Work: $ XD�a <br />Proposed Use of Building: to <br />Heat Source: []Gas 26ectric []Other <br />Building Type: FR-Detached ❑SFR-Att ched ❑Duplex ❑Multi -Family-# of Units: ❑Commercial ❑Industrial <br />Type of Project: ❑New ❑Addition E4Frernodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />'! JJ - S r -� t-�' tkr boM _ APO <br />A13C�-fmcryyls_ <br />AS IATED BUILDING PERMIT # (if applicable): <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 />V <br />Toilet <br />Backflow Preventer (Inside Bldg) <br />I <br />Forced Air Systems <br />C, <br />Unit Heater <br />Bathtub <br />Urinal <br />Gas Piping <br />d <br />Boiler <br />Lavatory (Wash Basin) <br />Drinking Fountain <br />H I <br />Water Heater <br />Refrigeration <br />1 <br />Shower <br />Floor Drain <br />Gas Fireplace <br />Q <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 />I <br />Range Hood <br />Water Heater <br />Other: <br />Exhaust Fan <br />Sink (Service/Bar/Mop/etc.) <br />Other: <br />SPRINKLER <br />/ SUPPRESSION <br />SYSTEM <br />Chemical or Water <br />No. of Heads <br />ACKNOWLEDGEMENT. l 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. l am the owner, or l 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 RCIN and 296.200A WAC. . <br />12- 5- <br />Date <br />City of Everett Official Use Only <br />PERMIT# <br />(Revised 912312016) <br />II <br />