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PERMIT APPLICATION <br /> BUILDING 1 MECHANICAL 1 PLUMBING 1 SIGN 1 SPRINKLER 1 DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425257.8857 1(E)everetteps@averellwa.gov I www.everettwa.gov/parmlts <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: �I IDZriJ �N�TROPERTYTAX#: <br /> LEGAL for new construction. Short Platlsubdivislon Lot No. (attach copy of long legal descriptlon) <br /> CONTACT INFORMATION <br /> OWNER NAME: LJLeT �t ti}a TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CRY STATE <br /> OWNER PHONE: — q 0 OWNER EMAIL: <br /> CONTRACTOR NAME: h <br /> CONTRACTOR ADDRESS: STREET l5' 3root wa <br /> CITY STATE IP 1, ZZ <br /> CONTRACTOR PHONE: Z, 2.S (V&G4 CONTRACTOR EMAIL:al-WeC-rAke*+1h • com <br /> CONTRACTOR LICENSE#(REQ1JIRED); CrAHeA1:-*0c1qRq I CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): O (P bQ$ <br /> PRIMARY CONTACT: ❑OWNER ((CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2-525q <br /> CONTACT EMAIL: a Wig cm h e(r f 4q . ca v-yl <br /> 13UILDING PERMIT APPLICATION <br /> ExIsOng Use of Buildin Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: JAGas ❑Electric ❑Other <br /> Buildin T e: ❑SFR-Detached FR-Attached []Duplex ❑Multi-Family-4ofUnits: ❑Commercial []Industrial <br /> T e of Pra ect: ❑New ❑Addition ❑Remodel '013epair [IT.]. ❑SI n ❑S dnkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> -jmb-M-L 6i�S WNA&c <br /> ASSOCIATED BUILDING PERMIT#(If applicable): <br /> MECHANICAL PERMIT.,APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo of Project: _,Now,_ Addn "Alteration Repair Type of Project: _,_,Now _Addn lAlteratlon WRepair <br /> #of List of Fixtures #of List of FWuras #of List of Axturas #of List of Fixtures <br /> Fixtures Fixtures Flxturos 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 Boller Lavatory Wash Basin Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove I 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 ServicelBaf/Mo /etc. Other. <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT f have reviewed this applicatlon and confirm the information contained herein is hue and correct.Work done pursuant to this permit must comply with <br /> current federal,state,and focal 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 Offklaf before being authodzed under any circumstance.i am the owner,or l am authorized by the owner of this property to perform the work for which application is mad.:-, <br /> and i complywith the State Contractors Law 18.27 PCW and 298.2004 WAC. <br /> City of Everett Official Use Only <br /> PERMI # <br /> wnorlAulhorized Atqt Signature n Date (Rovined 1(11220 5) <br />