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0 PERMIT APPLICATIOS <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLERDEMOLITION <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 /> (Blue or Black Ink Only Please) PROJEGCT� SITE INFORMATION <br /> PROJECT SITE ADDRESS: 0 I)© Ca,�ly' PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME CC—A' TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 'TbO <br /> CITY STATE LAZA ZIP <br /> OWNER PHONE: OWNER EMAIL: J ct' t N -tv or <br /> CONTRACTOR NAME: W % fftAl <br /> CONTRACTOR ADDRESS: STREET 33/0 PAVAA).-PST <br /> CITY STATE WIC, ZIP ?-0 <br /> 1 <br /> CONTRACTOR PHONE: ` 1 CONTRACTOR EMAIL: ( �;:S Vu(P4 Y ee <br /> CONTRACTOR LICENSE#(REQUIRED)W F,&--K,&M7-q N W CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):0-33Z <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L( Z'5 <br /> CONTACT EMAIL: n1 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: OA&I C0Contract Price of Work:$ 06 <br /> Proposed Use of Building: Dej u-I S Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <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 I L <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.l 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 98.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT#b ( 0 <br /> Owner/Authorized-Agent Signature Date (Revised 5/20/2096) <br />