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OLTPERMIT APPLICATIC:_" <br /> BUILDINU I MECHANICAL / PLUMBING / SIGIITSPRINKLER / DEMOLITION <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 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:66— 33 ,:c) PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Cc leio ',- N /c fee 111-1-14`A•iNK7 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 6/5- 3}/3 (-L." 5t <br /> CITY E U e P`� STATE w� ZIP /v?cI <br /> OWNER PHONE: L{-Z S 3 5-9— 8cr 3 OWNER EMAIL: <br /> CONTRACTOR NAME: (:)AN <br /> E P <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: „ OWNER ❑ CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 1-t.Z . 3 — 3 <br /> (4 1-e(o N -114w 47 CONTACT EMAIL: CA/e(o /4-1g 6 i 1 CU <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 5/— /Z Contract Price of Work:$ ✓ <br /> Proposed Use of Building: 5 Heat Source: ❑Gas 0 Electric ❑Other <br /> Building Type: ['SFR-Detached ❑SFR-Attached ['Duplex ❑Multi-Family-#of Units: ❑Commercial 0 Industrial <br /> Type of Project: ❑New ['Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ['Demolition 1 D'Change of Use <br /> DESCRIPTION OF WORK: Po r-GV) jre M©cl e 1 . er►v.;e 141-r u„cI ✓e t'7 I Wit" eG 7 r�1 PPG pa, <br /> 3077c1 (tiviee jLAfl CAv-C) Sfie V5 <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 List of Fixtures #of List of Fixtures <br /> Fixtures List of Fixtures Fixtures List of 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.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# <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) 'I2: <br />