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El <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 />PROJECT SITE INFORMATION <br />PIQ �T SIT R SS: <br />.� Y• W �� <br />PROPERTY TAX #: z� <br />Cz L <br />LEGAL for new construction: Short Platisubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: •- ; • S'( Pyo \1 TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET C [ HD// (/Y <br />CITY Cave Yelt STATE (JIV 1 ZIP ?JZ0451 <br />OWNER PHONE: , ` '.� �� O 5t) U <br />OWNER EMAIL: <br />CONTRACTOR NAME: VvrtALN (,I <br />CONTRACTOR ADDRESS: STREET C��1\4- ZZ /�� S!%'• X'��%'� <br />CITY �"T TTLZIP ' 4­11 <br />CONTRACTOR PHONE:Zr�"-��� <br />-�STATE <br />CON/TRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED):CL ��i �� O>� <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />l l\ �7 Cti1 <br />CONTACT PHONE: <br />CONTACT EMAIL: <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: aW Tc\'Mv1�lContract <br />Price of Work: $ U`- <br />Proposed Use of Building: Heat <br />Source: ❑Gas AElectric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex Multi -Family-# of Units: ❑Commercial ❑Industrial <br />Type of Project: ❑New ❑Addition ❑Remodel epair ❑T.I. [:]Sign ❑Sprinkler ❑Demolition ❑Chan e of Use <br />DESCRIPTION OF WORK: <br />f� 6)6feV ibY (�G(ll b�/C1ll <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />PLUMBING PERMIT APPLICATION <br />MECHANICAL 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 />Number 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAG <br />Owner/Authorized Agent Signature Date <br />City of Everett Official Use Only <br />PERMIT # <br />2 <br />(Revised 1011212015) f <br />