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PERMIT APPLICATI <br />BUILDII IU / MECHANICAL / PLUMBING / SIGId"1 APRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />467T 3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I yAvw.everettwa.gov/permits <br />;,ROJECT SITE INFORMATION ... <br />(Blue or Black Ink Only Please) P <br />PROJECT SITE ADDRESS: <br />PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT, INFORMATION <br />OWNER NAME: (� TENANT NAME (If Commercial): 9j Vatn <br />OWNER MAILING ADDRESS: STREET ZZ079 L, <br />CITY V STATE ZIP 9 2V <br />OWNER PHONE: Z�j 'LS <br />OWNER EMAIL: <br />CONTRACTOR E AA M14b <br />CONTRACTO ADDRESS: STREET <br />STATE ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQU ED): <br />PRIMARY CONTACT: OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />CONTACT PHONE: S2 —5400 <br />CONTACT EMAIL: Ci r- O I L <br />BUILDING PERMIT APPLICATION . <br />Existing Use of Building: <br />Contract Price of Wo C7 <br />Proposed Use of Building: <br />Heat Source: Ga ❑Electric FID6tH r <br />Building Type: ❑SFR-Detached ❑SFR-A ached ❑Duplex ❑Multi -Family-# of Units: Commercial ❑Industrial <br />Typ of Project: []New ❑Addition emodel ❑Repair ❑T.1. ❑Sig ❑Sprinkler ❑Demolition []Change of Use <br />D SCRIPTION OF WORK: <br />ZA-0 V2 L009-- dR GI C.r 'rW W AW-v- L M P IZ"V1rNAvcpJT' <br />►2-ti 7XU,) 13 S V vw tc-&-_ � [Lt1 Iv <br />SOCIATED 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 Hand'ng Units <br />Heat Pump <br />Toilet <br />ckflow Preventer (Inside Bldg) <br />Forced Air Syst s <br />Unit Heater <br />Bathtub <br />Z <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 okups <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./ 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 eing uthorized under any circu ante. 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 atentractors Law 1�7545W16nnd 296.200A WAC. <br />City of Everett Official Use Only <br />/ P RfO41T# <br />(Revise 5/ 0/2016) <br />j(4 <br />01 <br />