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PERMIT APPLICATION <br /> /IIPW'"":1 <br /> BUILDING I MECHANICAL I PLUMBING I SIGN i SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> '41IW . <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 /> PROJECT SITE INFORMATION. <br /> PROJECT SITE ADDRESS: �) ` Uri iQ n y��v/ /A 11 OPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision '7 (/L{Y 7L Lot No. (attach copy of long legal description) <br /> ;,, CONTACT 1RIFORMATION <br /> OWNER NAME: aal"e 1 1 1r ► TE NT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ( \R I-2 <br /> CIQ. / STATE l ZIP Ce <br /> OWNER PHONE:{av--, `�j5 l �� OWNER EMAIL: <br /> CONTRACTOR NAME: CJIA1 <br /> CONTRACTOR ADDRESS: STREET <br /> MY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILD1NO. PERMIT APPLICATION ,I <br /> Existing Use of Building: IIN ! Contract Price of Work:$ L\DOD (J` <br /> Proposed Use of Building: 1n � Heat Source: OGas ❑Electric DOther <br /> Building Type: SFR-Detached v 4 DSFR-Attached ❑Duplex DMulti-Family#of Units: ❑Commercial Dlndustrial <br /> Type of Project: ONew DAddition @Remodel @Repair OT.I. OSign @Sprinkler @Demolition @Change of Use <br /> DESCRIPTION OF WORK: <br /> \C roof <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> :MECHANICAL PERMIT APPLICATION PLUMBLNG 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 /> NC—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 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.1 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 /> 4 <br /> ().___R <br /> City of Everett Official Use Only <br /> 1 PERMIT# <br /> 0 nerlAuthorized Agent Signature Date (Revised 10/1212015) <br />