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PERMIT APPLICATI <br /> BUILDI& MECHANICAL I PLUMBING I SIG PRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERV'V/111 ' <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.govlpermits <br /> PROJECT SITE ADDRESS: <br /> PROPERTY TAX 4: <br /> LEGAL for new construction: Short Plat/subdivision_Lot No. (attach copy of long legal description) <br /> OWNER NAME: JL)e— 'Ll I(, S TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET "J <br /> My STATE ZIP <br /> CONTRACTOR PHONE; q;211 �6-, 1CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 09LfiL <br /> PRIMARY CONTACT: El OWNER EICONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: —]CONTACT PHONE: 9 6 6 <br /> ICONTACT EMAIL: <br /> Existing Use of Building: lContract Prime of Work- <br /> Proposed Use of Building: Heat Source: []Gas ElElectric [--]Other_ <br /> Building Type: EISFR-Detached EISFR-Attached ODuplex E]Multi-Family-#of Units: MCommercial ElIndustrial <br /> Type of Project: ONew MAddition ORemodel EIRepair EIT.I. OSign OSprinkler OlDernolition OChange of Use <br /> DESCRIPTION OF WORK: -nce <br /> e /,,(� -� � H <br /> ,ASSOCIATED BUILDING PERMIT#(if applicable): <br /> LICATIO <br /> 6 EOMIT-APP: N <br /> kAk <br /> te JOWPERMIT-� <br /> Type of Project: _.New _ Addn __Alteration _.Repair Type of Project: _New __Addn Alteration _Repair <br /> #Of <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures List of Fixtures <br /> Fixtures A/C—Air Handling Units Fixtures Heat Pump Fixtures 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 /> -.14rO. T <br /> Wile S <br /> I — 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.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 State Contractors Law 18,27 ROW and 296.200A WAC. City of Everett Official Use Only <br /> FPERMIT# <br /> Owrlor/Authorized Agent Signature Date (Revised 10112J2015) <br />