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PERMIT APPLICATION <br /> BUILDINGRECHANICAL/ PLUMBING / SIGN / S RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OL 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: a�L-4f�rYl�1 Al/G PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No- (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: iff R i C- -J C-z�1'456 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET til G �7 <br /> CITY t I l<C �T YGsA�.0 STATE G(// zip 'I �7 S'& <br /> OWNER PHONE: y Z 3 3 a - o L-!c/ OWNER EMAIL: L .T J O y It Y �!�r/o D ,C-t0/✓i <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: 2/C" 1/-0 ? CONTRACTOR EMAIL: /.�%rl /�/�z�� -�✓�r' <br /> CONTRACTOR LICENSE#(REQUIRED): ;2.E7• , _w C CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):0D�/_l �2'? <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: k, <br /> CONTACT EMAIL: .Q-Jh-7 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ ,3 7-Yo <br /> Proposed Use of Building: S �/z 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 WSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> A-' <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 <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 /> PERMIT# <br /> Owner Xut�Agent Signature Date (Revised 101121201 ) , <br />