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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OL3200 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: �j(�f(' (/Qr{ �.) ROPERTY TAX#: <br /> LEGAL for new constructionSnort PlaUsubdivision Li Lot N ch copy of long legal description) <br /> CONTACT INFORMATION . <br /> OWNER NAME: �(� �,(� nPW4 4 L't, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRES:i: STREET l <br /> CITY � �j STATE �� ZIP <br /> OWNER PHONE: OWNER EMAIL: 60^5 <br /> CONTRACTOR NAME: �ON/���'l <br /> CONTRACTOR ADDRESS: STREET L1J ry 45, � / <br /> CITY STATE W�'�}- ZIP 0/4 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: ,`��l✓'` <br /> CONTRACTOR LICENSE#(REQUIRED): b b CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER CONTRAC OR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 81 <br /> uzy' MNZ4'tJ CONTACT EMAIL: J-Pict. rhareawvLx>.6eifoe. ✓� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Mv1�'— Contract Price of Work: $ IQOW <br /> Proposed Use of Building: :l Heat Source: ❑Gas ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ZIRepair ❑T.I. []Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: j � �1 �jn =t��t <br /> f Y �o 6,T(t�FQG 'I'o /4Ta�5 co,,•.�% <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <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 /> 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/SUPPRESSION 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 deral,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 /> Buildi g fficial b re eing 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 Com ly witUeontractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only <br /> PERMI�#.r/A rizure Date (Revised 5/20/2016) <br />