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• PERMIT APPLICATION • <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 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> "/PROJECT SITE ADDRESS: � j22— L�(�� ✓l PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Cc.,L)ck^e TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY ue\ e--t` STATE (A ZIP(-3(gZ( <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: • <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> 7(CONTACT NAME: CONTACT PHONE: eZe:;), ( <br /> (' &,ter M Le- l i L- 3 CONTACT EMAIL: �1 l <br /> BUILDING PERMIT APPLICATION <br /> ®v <br /> Existing Use of Building: Contract Price of Work:$ �. .. �7 O D <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition El Remodel El Repair DT.I. ❑Sign DSprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK:,176 7 � � pu)C�� <br /> ASSOCIATED BUILDING PERMIT Pfire,of <br /> cae) <br /> 1\�/ G'1 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water 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 Weil before bein 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 c mply,with th St C tractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ' I PEFI� Q5i <br /> Owner/AMthorized ge t Signature Date (Revised 9/23/2016) <br />