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PERMIT APPLICATIO* <br /> BUILDING-/ MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> OL (P)425-257-8810 1 FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 12_( 1�Tii �� �� PROPERTY TAX#: ®b7 /�80bb Sp p <br /> LEGAL for new construction: Short Plat/subdivision SuAlPal-rE b)V. Lot No.Sa (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ®���f✓EA jEkTq TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 12-(e SF— <br /> �" <br /> `/ CITY �j�(�/L+Li// STATE A ZIP O �� <br /> OWNER PHONE: `/ 2-5 ��/f- �oZ��- OWNER EMAIL: <br /> CONTRACTOR NAME: blMAA ZG <br /> ,EA4o <br /> CONTRACTOR ADDRESS: STREET /O 1-2— I AlAl 5� <br /> CITY ��L ISS <br /> STATE VA ZIP <br /> CONTRACTOR PHONE: lLS -7bo Ak, <br /> b CONTRACTOR EMAIL: SGI��A^✓ 'DEQ Z L MS's' <br /> CONTRACTOR LICENSE#(REQUIRED): 5uA/A64F�O&3:5S ICITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 7 Zo5 <br /> PRIMARY CONTACT: ❑ OWNER ONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: X`I/IA/ CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION 1 GG <br /> Existing Use of Building: Contract Price of Work: $ <br /> Proposed Use of Building: Heat Source: ❑Gas ZLFIectric El Other <br /> Building Type: FR-Detached -Attached El Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition emodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> �n/�LC,ING� iQ NAL✓ ,�vc�!-SSS �EA�ItI//Lt,� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn KAIteration _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 Fi es 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 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 RCW and 296.200A WAC. <br /> dd City of Everett Official Use Only <br /> PERMIT# <br /> Owner/Authorizl VAgenti ature Date (Revised 10/12/2015) `/ <br />