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OLT— PERMIT APPLICATION <br /> BUILDING / MECHANICAL / PLUMBING / SIGN I SPRINKLER/ DEMOLITION <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 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ; PROPERTY TAX#: <br /> �}l 5 (,,L"1-�r y-�ca cJSf' <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> /� <br /> / / CONTACT INFORMATION <br /> OWNER NAME: Oc ,1cc Ld {.-c TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET y?-( , /44 1. i•-cLc .4 Lir <br /> t�CIT`Y £'• 1� :/ STATE (� :41 • ZIP C7 it 2-t: 3 <br /> OWNER PHONE: ] 15--O �S `j - 6 4.--3 OWNER EMAIL: <br /> CONTRACTOR NAME: OtAJ /V <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> 7. <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR OTHER(Please Specify) Fr/e-d►•c( <br /> CONTACT NAME: CONTACT PHONE: LI <br /> 1 ` / "" ller vCONTACT EMAIL: JerilP�t�ic� , CCy"y ' <br /> BUILDING PERMIT APPLICATION 1 <br /> Existing Use of Building: ContraqPrice of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric DOther <br /> Building Type: ❑SFR-Detached DSFR-Attached ODuplex ❑Multi-Family-#ofOrlits: DCommercial ❑Industrial <br /> Type of Project: ❑New DAddition DRemodel ❑Repair DT.I. ❑Sign ❑Sprinkler ❑Demolition DChange of Use <br /> DESCRIPTION OF WORK: <br /> A !'hur cir- 4 cieNil f ate. oy-$ ci <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 Fixtures List of Fixtures Fixtures I 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:l 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# i p'/ <br /> 114 "� 11 Dat r 6 (Revised 10/12'1 ni ( �Vv i 1 \U O I tr Ali <br /> Owner/Authorized Agent Signature <br />