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PLRMl1APPLlGATlU <br /> BUILDING*IECHANICAL/ PLUMBING I SIGNNORINKLER I 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.everethva.govipermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: GX R&w..W, Lvig� ,A YINI 1PROPERTY TAX#: 00 73 W(0 00 <br /> LEGAL for new construction: Short Ptatisubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME,:, Dol —Lm TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Ais- <br /> CITY To�COW C1 STATE U/14 ZIP <br /> OWNER PHONE: 1OWNER EMAIL: Jqvllrobrr� lee-, Com <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> Clily I M STATE W9 —ZIP <br /> CONTRACTOR PHONE: �- 5 1CONTRACTOR EMAIL: f6DQ��Qk <br /> CONTRACTOR LICENSE*REQUIRED): RE 5 OL V III V I CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: E40WNER OCONTRACTOR D OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: lContract Price of Work: $ <br /> Proposed Use of Building: lHeat Source: ©Gas (Electric ©Other <br /> Building Type: OSFR-Detached ©SFR-Attached []Duplex ©Multi-Family-#of Units: ©Commercial ©Industrial <br /> TypeofProject: []New OAddition ORernodel ©Repair OT.I. O$ign OSprinkler 0[lemolition ©Chan geofUse <br /> DESCRIPTION OF WORK, il ql�u WnA4 Ck 61 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: —New — Addn —Alteration X Repair Type of Project: _New —Addn —Alteration K Repair <br /> #of of #of #of <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of 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 (Servicel'Bar/Moplietc.) -Other: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> ]Number of Heads <br /> ACKNOWLEDGEMENT-I have reviewed this application and confirm the information contained horein is live and correct.Work done pursuant to this permit rriust co,rnply 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 Ocial before being authorized under orgy circumstance.I am the owner.or 1 am authorized by the owner of this property to porfbrnr the work for which application is nIack, <br /> and I com4lAwilS",to Contractors Law 18.27 RCW and 2913.200A WAC. <br /> PERMIT City of Everott Official List,Only <br /> �71 � ( 0 o (I,—on <br /> OwnertAuf prized Agent Signature Date (Revised 5120,2016) <br />