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• PERMIT APPLICATIOA <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <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 />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS:Ave ! <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: L L 7-1221 . •;or% I_ L-(; TENANT NAME (If Commercial): <br />r <br />OWNER MAILING ADDRESS: STREET I S 1 AJ <br />CITY - STATE ZIP <br />OWNER PHONE: ('> -'� etc ::�6 <br />OWNER EMAIL: '. C) <br />CONTRACTOR NAME: f` <br />CONTRACTOR ADDRESS: STREET ' -r <br />CITY t STATE 1VA ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: 6,y <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(R UIRED): <br />PRIMARY CONTACT: '; OWNER ;4 CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />5 y <br />CONTACT PHONE: Q ._7 <br />CONTACT EMAIL: <br />UILDING PERMIT APPLICATION <br />Existing Use of Building: • 111 w 1, 6 M <br />Contract Price of Work: $ <br />Proposed Use of Building:I <br />Heat Source: []Gas RElectric ❑Other <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 />-rG►��; ly 3 At-t- tied Hei e <br />�� �i-ow� � >7 S <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 />Fixtures <br />List of Fixtures <br />Fixtures <br />List of Fixtures <br />Fixtures <br />List of Fixtures <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 />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. 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 />PERMIT # <br />(Revised 912312016) I <br />