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0 0 <br />PERMIT APPLICATION <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 />(Blase or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: C <br />PROPERTY TAX #: '4 _- p <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): <br />OWNER MAILING ADDRESS: STREET 12 r-- <br />CITY STATE ZIP61 <br />OWNER PHONE: J `� _ — <br />OWNER EMAIL: <br />CONTRACTOR NAME: Agg4krA C&Ajamsrmwicgs, <br />CONTRACTOR ADDRESS: STREET Z?ZS Ar <br />CITY STATE LOA ZIP Q ' <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): KAk-r <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR XTHER (Please Specify) <br />CONTACT NAME: <br />�ILL{8 <br />CONTACT PHONE: <br />CONTACT EMAIL: 'I S <br />uc* , d6m <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: <br />Contract Price of Work: $ Z56 <br />Proposed Use of Building: <br />Heat Source: []Gas 'M�Iectri. []Other <br />Building Type: ❑SFR-Detached FR-Attached ❑Duplex ❑Multi -Family-# of Units: ____ ___---- ❑Commercial ❑Industrial <br />Type of Project: ❑New ,M4ddition ❑Remodel Xepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: e <br />,Fey D, �,�-- &E411J IL-0 F0- warms � Fes, PAOTW, APP`,) ) <br />j n lr, .RcT. /45 • <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />PLUMBING PERMIT APPLICATION <br />MECHANICAL <br />PERMIT APPLICATION <br />Type of Project: <br />,�z�: New _ Addn _Alteration <br />,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 Handlinq 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 />I <br />Shower <br />Floor Drain <br />Gas Fireplace <br />Wood Stove <br />I <br />lKitchen 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 />YVaterHealeir1f �- <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. 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 comaly with the State Contractors Law 18,27 RC'W and 296.200A WAC. <br />City of Everett Official Use Only <br />2/U � � PE T # �q-o Z I C-� <br />Signature Date (Revised 912312016) <br />Ill <br />