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• PERMIT APPLICATION* <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OL 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 /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ROPERTY TAX#: C -, <br /> G`� <br /> L ,'�\C.1�c�v�(:�t tr LA'3 \ ��� t UCJ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: v� j-{ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET t V 2 T VL- <br /> CITY C STATE ZIP <br /> OWNER PHONE: '� '-30 ( - OWNER EMAIL: <br /> CONTRACTOR NAME: mhea <br /> / <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: XOWNER ❑ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: S)"c.c o He n­cS u 9mcc V Cc.;jYl <br /> ` BUILDING PERMIT APPLICATION <br /> Existing Use of Building: S Contract Price of Work:$ G f� <br /> Proposed Use of Building: 56 Heat Source: Gas ❑Electric ❑Other <br /> Building Type: FR-Detached ❑SFR-Attached []Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition XRemodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition []Change of Use <br /> DESCRIPTION OF WORK: <br /> FIN'Sµ A3A%CkktAj'T. WSk-,,U \L At�-Z) 'WALL QASL. �''Ek) , wj� ' S A\-'V-'S, <br /> OV V;(TCI- ,5, W ALL Ar l,� v'?S i A \V-S ��-��t ice` 1,�!'rLl— , IYnSvi.A-i <br /> ASSOCIATED BUILDING PERMIT#(if a licable): <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-Ar 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: -,����C y <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/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMI <br /> I ner/Authorized Age ature Date (Revised 10/1212015) <br />