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0 PERMIT APPLICATIOP <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: r PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: DANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 23 Z el r.e ,I <br /> l�/ CITY b STATE ZIP <br /> OWNER PHONE: � O OWNER EMAIL: <br /> CONTRACTOR NAME <br /> CONTRACTOR ADDRESS: STREET <br /> CITY Y^�' STATE LJ ^ ZIP <br /> CONTRACTOR PHONE: t-1 C CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED)RLMEBI: CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):LIS ZaAL <br /> PRIMARY CONTACT: ❑OWNER ONTRACTOR ❑ OTHER (Please Specify) <br /> CONTACT NAME: ` T PHONE: <br /> � CONTACT EMAIL <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: lContract Price of Work-$ <br /> Proposed Use of Building: Heat Source: as ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached El Duplex ❑Multi-Family-#o nits: — ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair El T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: <br /> Li Vt t ry -0AvvmoL9-- <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 /> Fixtures List of Fixtures Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> 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. 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 RCW and 296.200A WAC. <br /> / City of Everett Official Use Only <br /> C( <br /> b 1 � / S— PEM , L0 1 _ ()�� <br /> Owner/Aut rized Agent Signature Date (Revisedd 1012/2015) <br />