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PERMIT APPLICATION <br /> BUILDING /*CHANICAL / PLUMBING / SIGN / INKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OL <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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: � l/ C-S C ";t v e- S -t r q-z PROPERTY TAX#: (DQ '7 37 Q/Z® ) <br /> LEGAL for new construction: Short Plat/subdivision 77S-7 Z—)—00 Lot No.12-16 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: r y F(. TENANT NAME (If Commercial): , N,C o c <br /> OWNER MAILING ADDRESS: STREET Z L �(- AL/C.- <br /> CITY Ver STATE Ll//A- ZIP z % <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: (,Q r',-f o e-J 7,t r-7 f%L q (^ e <br /> CONTRACTOR ADDRESS: STREET Za 2 C `t- /v F <br /> CITY A, —(" L-/,4 STATE Z/IP 1X700 <br /> OV(_? z <br /> CONTRACTOR PHONE: (1/Z f Z '; ( q' 7CONTRACTOR EMAIL: J s?SSS I"��p ('i--(Lj <br /> CONTRACTOR LICENSE#(REQUIRED): �r(� l�C CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):O <br /> PRIMARY CONTACT: ❑ OWNER 'CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> / <br /> Te- S.e_ C�17L � ��A CONTACT EMAIL: <br /> , C9411 or U �+ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: , S Contract Price of Work: $ �. � 6 3© <br /> ,YJ <br /> Proposed Use of Building: Heat Source: ❑Gas Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex []Multi-Family-#of Units: "O ommercial ❑Industrial <br /> Type of Project: ❑New 2rAddition ❑Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: R e,ef dL ` C1 Zjr-1 (-.qo4, 4o 1 hea4- 49r <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 #of #of #of <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures I 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 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 RC W and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 1 Owne uthorized Agent Signature Dat (Revised 5/20/2016) <br />