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6 PERMIT APPLICATION 1110 <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 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ,, S--20 V `c fpc /O/ PROPERTY TAX#: OO 5 S 3(oOWD100 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 16,0,,,,,o f h"a u.pr TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET AsZ 0 U r cr jfi/ <br /> CITY 4-vet e tie. STATE a ZIP U _70/ <br /> OWNER PHONE: 2 S S.-A 3 OWNER EMAIL: cq,,tthits-c --iryi4,ff I(U41 <br /> CONTRACTOR NAME: a(461/Pr <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT:9WNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION ` , ci <br /> Existing Use of Building: Contract Price of Work:$ ,�I�� �W aC�C_ <br /> Proposed Use of Building: Heat Source: 3as ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached El Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: El New ❑Addition ❑Remodel LQRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DE CRIPTION OF WORK;_. T <br /> e,j f arc' e reS 1 Sii i't5 act' 4 icti cc e L' r ik tie Ai c2"°e <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLI ION <br /> Type of Project: _New_ Addn _Alteration _Repair Type of Project: _New _Addn • teration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fo t es <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& ■.-posal Grease Trap <br /> Gas Range / Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes W- her Medical Gas <br /> Range Hood Water --ater Other: <br /> Exhaust Fan Sin ervice/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> !Chemical or Water ! 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 Sta ontracto Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 0/J� /1? PE <br /> R>> Imo# , 1 0 o� <br /> Owner/Aut o ed Age i ature (Revised 9/23/2016) <br />