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0 PERMIT APPLICATION* <br />BUILDING / MECHANICAL / PLUMBING / SIGN I 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) PROJECTSITE INFORMATION <br />PROJECT SITE ADDRESS: o j <br />C.�� A4 G- <br />PROPERTY TAX #: (04- (t ®12,:2 <br />LEGAL for new construction: Short Plat/Subdivision Lot No. 29 (attach copy of long legal description) <br />CONTACT INFORMATION <br />/� <br />OWNER NAME: OL- C �L� �/� TENANT NAME (if Commercial): <br />OWNER MAILING ADDRESS: STREET' <br />CITY 9Z F-T' U STATE A 1% ZIP 1,127- <br />OWNER PHONE: .qz�� <br />OWNER EMAIL: <br />c�� <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) a <br />CcO-N�TACT NAME: <br />CONTACT PHONE: 47-s <br />CONTACT EMAIL: t>Ate( %�'�"f�' Ac>U cc4" <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building:- <br />Contract Price of Work: $ <br />Proposed Use of Building: >- <br />Heat Source: []Gas ❑Electric XOther A10W P <br />Building Type: ❑SFR-Detached ❑SFR-Attached Duplex ❑Multi -Family-# of Units: ❑Commercial ❑Industrial <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign []Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />— <br />� A 2�" X Q ` -Pave Quv �°� a�ca 1A Y tAr. i bd tkw' <br />ASSOCIATED 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 />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 />/ SUPPRESSION <br />SYSTEM <br />Chemical or Water <br />I I <br />No. of Heads <br />ACKNOWLED .EMENT.- 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 feder , sta e, and local law. TfNranting of a permit only authorizes approved work and no deviations therefrom. Deviations must first be authorized in writing from the <br />Building O cial be re being autho zed LXder any circumstance. I 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 co Iv with 1he Stale Contractors La 18._>7 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />t <br />PERMIT -601-1 <br />Agent fignature Date (Revised 912312016) <br />L10 <br />