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a PERMIT APPLICATIOIS <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />4,ETT 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 />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: I� tii v v • / q <br />PROPERTY TAX #: <br />JJ b b lJ (� (v �1 <br />LEGAL for new construction: Short Plat/subdivision <br />Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: V/C+o -I a 6�A <br />TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET q p C( (S Pj <br />S C✓ <br />CITY F Je — <br />STATE 14 <br />ZIP <br />OWNER PHONE: t'12 S' -7 6 o 3 7 �-1 <br />OWNER EMAIL: ur s e o i w S L(2 (k <br />CONTRACTOR NAME: - r <br />CONTRACTOR ADDRESS: STREET <br />CITY <br />STATE <br />ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: 0 OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />CONTACT PHONE: <br />CONTACT EMAIL: L o rub <br />BUILDING PERMIT APPLICATION s <br />Existing Use of Building: ` ji k, \ � I`- P <br />Contract Price of Work: $ io U O <br />: c <br />Proposed Use of Building: C e <br />Heat Source: ❑G ctric <br />Other <br />Building Type: ❑SFR-Detached MFR-Attached ❑Duplex []Multi -Family-# of Units: .y ❑Commercial ❑Industrial <br />Type of Project: ❑New EgAddition []Remodel ❑Repair <br />❑T.I. ❑Sign ❑Sprinkler ❑Demolition <br />❑Change of Use <br />DESCRIPTION OF WORK: <br />l.)-LY (' vJ <br />n/� � r u �" (-- 3�.n.. --'r � r C .: ; �L�.,� "i'• ..- ( � :�., ._ z �� «,n. =:�. , j(- r�. � �., •^'l +,cu.,�- : `. <br />(o �.�' y r ••� s wn Jl f t �. J CuL <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 <br />_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 />_ <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 />ishwasher <br />Roof Drains <br />Clothes Dryer Hookups <br />Other: <br />lothes Washer <br />Medical Gas <br />Range Hood <br />. <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 <br />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, 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 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 />PE IT # <br />j P- UCH <br />Owner/Authorized Agent Signature Date (Revised 912312016) <br />1 � <br />