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PERMIT APPLICATION <br /> 110,./,!"4"L"-P*;Aik BUILDING ; MECHANICAL / PLUMBING / SIGN / 11:: itINKLER r'EMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.govlpermits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 13/4 S - !PROPERTY TAX#: <br /> 4182.451 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (br(-of -i°- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /zet. :'ALX <br /> n ), Gti ¢ / ) y� p 7� <br /> CITY J !,- -1,IP i.r, ZIP /Obi✓/ <br /> OWNER PHONE: `- -$cf- r `f OWNER EMAIL: <br /> CONTRACTOR NAME `r(rj0 <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STA--E ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED!: CITY OF EVERETT BUSINESS LICENSE#REQUIRED): <br /> PRIMARY CONTACT: ,}OWNER 0 CONTRACTOR 0 OTHER(Please Specify) _ <br /> CONTACT NAME: Qret/tdgt CONTACT PHONE: c.lt ,s-3fS�`S CXn/ <br /> CONTACT EMAIL: be l yid.erperry-o .t, .r :c .ri <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: ❑New DAddition C]Remodel ❑Repair DT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Chance of Use <br /> DESCRIPTION OF WORK: <br /> G INL O S-h'1A-C-k 4le., <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 #of #of #of <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of 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.lam 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/Authorized Agent Signature Date (Revised 71/12/2.0151 <br />