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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 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJSITE I FORMATION <br /> PROJECT SITE ADDRESS: (.1 O`"2. SO JPROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision ` Vot No. (attach copy of long legal description) <br /> CONTAC NFORMATION <br /> OWNER NAME: 1 z(ZTo'_AA r,;c-c1/W)E T TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET S R 24 40\t yUN('j V e, 5n1- <br /> crry <br /> n1f- <br /> CITY \ STATE \J 94 ZIP IQ 201,? <br /> OWNER PHONE: 90 6 `�j , ��8 a.- OWNER EMAIL: is-„eJ I <br /> T ' M; kQy p Q i ,u. v <br /> CONTRACTOR NAME: C" .Ln ~] <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: Of (9 4,9 8n 2f) CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: DOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: c2.0 6 ,/1 (�4 <br /> �/l' 1 CONTACT EMAIL: 3 lI c .iivtGi' ,l <br /> 1 f`1�1 4 el �'T1 /��-� '1, ' 4-�11 //A to e <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ RP')'D' <br /> Proposed Use of Building: Heat Source: . Gas ZElectric DOther <br /> Building Type: SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family #of Units: ❑Commercial ❑Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair DTI. ❑Sign OSprinakler ODDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: €_ _-1.,..4 ��, ,a,A <br /> { - a 1 `in-t row" 1 .-- icjl V. ,n <br /> A.C.tu_ _ fJ V e. ). G-1 E�c Yl c_04) 190-�44 4-s S, 1- s e„S 0� n 14 <br /> ASSOCIAT BUILBIIV&PER IT livable): ( ti.) <br /> V�L( ©t Q <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT A LICATION <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 #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-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 I SUPPRESSION SYSTEM <br /> Chemical or Water 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 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> 111° <br /> City of Everett Official Use Only <br /> CA ` 2)-1 – PEPS.--• l'ZOA — MI I <br /> Owner/Authorized A.4 gnature Date (Revised 9/23/2016) <br />