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'1 PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 73o—Ove-� <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits PW <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION .'�� <br /> PROJECT SITE ADDRESS: 50� til r�'r N D PROPERTY TAX#: G6 VA )04 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �(,r�/! � � , TENANT NAME(If Commercial): " eLEve:ly <br /> OWNER MAILING ADDRESS: STREET ? 100 It <br /> CITY 45; '�'T'rs STATE ZIP <br /> OWNER PHONE: /A OWNER EMAIL: <br /> CONTRACTOR NAME, <br /> CONTRACTOR ADDRESS: STREET TljIL � ` <br /> CITY p9 ' STATE �(�- ZIP 6 /33 <br /> CONTRACTOR PHONE: 266.- k-o r CONTRACTOR EMAIL: -5- " (A- 24A <br /> CONTRACTOR LICENSE#(REQUIRED): l7lao:�;j MD�72- G, CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)CI C <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: --30 —50-13 2— <br /> >4 °NL� CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ Z Z C) <br /> Proposed Use of Building: —eL'g;LV ovT j Heat Source: ❑Gas 11 Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached []Duplex ❑Multi-Family-#of Units: Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel Dirkepair ❑T.I. []Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <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 �xtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backfl reventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub U I <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove lKitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other:)qW62E12 Clothes Wash e Medical Gas <br /> Range Hood Water Healie< Other: <br /> Exhaust Fan Sink( ice/Bar/Mop/etc.) Other: <br /> t f,r <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Chemical or Water 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 t comply wi tate C ntract s Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ,?- PERMIT#e-L / , . I M 1 <br /> Own Author' ed Agent ig ure Dat (Revised 9/23/ 016) l <br />