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El <br />0 PERMIT APPLICATIOAS <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: 1510 <br />PROPERTY TAX #: <br />LEGAL for new construction: Short Plattsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: <br />TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET <br />.�-- <br />CITY STATE ZIP <br />OWNER PHONE: t? ?0 r ^ ® <br />OWNER EMAIL: .5c_v\Ae 10 —!.�t ( —owl <br />CONTRACTOR NAME: <br />CONTRACTOR ADDRESS: STREET <br />CITY STATE ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />CONTACT PHONE: <br />CONTACT EMAIL: <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: <br />Contract Price of W k: $ <br />Proposed Use of Building: <br />Heat Source: ❑Ga ❑Electric her <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 />2Qyv�.ave., �xr`S�°n� I?-oof _ 12e laces w f n eA�j 3 oy,2 comlO <br />t Q 0 L'6 <br />ASSOCIATED BUILDING PERMIT # (if applicable): w ` p O — q 002—, <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPW ATION <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 11 <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.' 1 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 circumstan the owner, or l am authorized by the owner of this property to perform the work for which application is made, <br />and I comply with the State Con ors La 18.27 RC 296.200 WAC. <br />City of Everett Official Use Only <br />P EAKT# <br />q -is�lg <br />Signature Date (Revised 912312016) <br />