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PERMIT APPLICAT4 <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> OL (P)425-257-8810 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: v-4 (" (,>vC PROPERTY TAX#: U act <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: i�1<<�I-�tr�%��`.=� -�y l 1''L1 TENANT NAME(If Commercial): J'Yljr7�(� - <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME:'—' j n(::!- <br /> CONTRACTOR <br /> 1(::!- <br /> CONTRACTOR ADDRESS: STREET 20(�j' )(Q y' A) <br /> CITY CLi c STATEZIP %, �90 <br /> CONTRACTOR PHONE: -71- 31 CONTRACTOR EMAIL: LOY if? <br /> CONTRACTOR LICENSE#(REQUIRED). (wt;-vr-,-M CITY OF EVERETT BUSINESS LICENSE#(REQUI D):(rj IAh <br /> PRIMARY CONTACT: ❑ OWNER CYCONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �,-- (�`7 f ( LI-3 <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION -�— —� <br /> Existing Use of Building: V : l Contract Price of ork:$ C <br /> Proposed Use of Building: Heat Source: ❑Ga ❑Electric_.. the, <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. WSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Yepic�c� <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 /> Chemical or Water I No. 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 Stat Contractors Law 18.27 RCW and 296.200A WAC. <br /> IT# <br /> City of Everett Official Use Only <br /> 311-7 -- ooh <br /> O er/A horized Agent Signature Date (Revised 9/23/2016) <br />