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PERMIT APPLICATIO <br /> BUILDIN / MECHANICAL! PLUMBING /SIGN / P <br /> GRINKLER/ 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 /> :S EI.NFO,RMATION <br /> PROJECT SITE ADDRESS: 4en'-Itr <br /> PROPERTY TAX#: <br /> LEGAL for new construction: Short Platfsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT Ipo1FORIVVrAT10N <br /> OWNER NAME: Elf n v r l 1� d TENANT NAME(If Commercial): 1111dvV lr vhf S"1 <br /> OWNER MAILING ADDRESS: STREET -7b 6 VABuz <br /> CITY V'e f STATE A ZIP <br /> OWNER PHONE: Z D 3Ll Cf 2_ OWNER EMAIL: <br /> CONTRACTOR NAME: <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: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2 D L -3 4 Gf 7 7 y(y <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑]Remodel ❑Repair ❑T.1. []Sign []Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 4 b(1 I VSs <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 /> S;PRLNKLER/:;:SUPPRESSION SYSTEM; <° <br /> Number 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 Oficial before being authorized under ny circumstance.1 am the owner,or 1 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 78 127,:?CW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ^% /0 � PERMIT# <br /> Iw Z - 5 - 1(, <br /> Owner/Autho zed Agent Signature Date (Revised /1 2015) <br />