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0 PERMIT APPLICATIOO <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 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: G ioyy <br /> 5� wa PROPERTY TAX#: n `00 <br /> Xt <br /> LEGAL for new construction: Short Plat/subdivision Lot No. l• (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: L TENANT NAME(If Commercial): I JA <br /> OWNER MAILING ADDRESS: 9 <br /> 6E <br /> STATEV`UH ZIP <br /> OWNER PHONE: Z • Z2 -3q 1OWNER EMAIL: '!G( <br /> CONTRACTOR NAME, CCGY)Ory-L cLr)� <br /> if <br /> CONTRACTOR ADDRESS: L9 C(51- aA/ •f I PAW DVIVE <br /> RwK CITY ' STATE ZIP q$2b <br /> CONTRACTOR PHONE: 1 3`r ry77 • CONTRACTOR EMAIL: C�r1 <br /> CONTRACTOR LICENSE#(REQUIRED):5CIAV D ?— CITY OF EVERETT BU INESS LICENSE#(RQUIRED): <br /> PRIMARY CONTACT: OWNER ❑ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: <br /> n�� ,rv�n CONTACT PHONE: �Z - ZZ3 <br /> V�v KI✓1XA lV CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ <br /> Proposed Use of Building: (,Qn �Q Heat Source: ❑Gas El Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached []Duplex Multi-Family-#of Units: Commercial ❑Industrial <br /> Type of Project: N.,v ❑Addition ❑Remodel El Repair ❑T.l. []Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> $,,�;� 1d� a 0-� O( w�f lavld(5 aarcw 0✓1 Ou t v-P�. <br /> 1n��vl, , Cep w-f ttn <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 federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations most first be authorized in writing from the <br /> Building Official before being authorized under any 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> I W City of Everett Official Use Only <br /> PERMIT# <br /> ��—/I��I�0�1 <br /> Own Authori ed A ent Signature Date (Revised 10/1 /2015) ` r <br />