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PERMIT APPLICATIQI I BUILDING / MECHANICAL/ PLUMBING / SIGN /SPRINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 OL (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS:.O �� PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: L-L' r! TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: Lf .Z 2-If OWNER EMAIL: Lc Y- 6 o L_ CONTRACTOR NAME; 1 fs CONTRACTOR ADDRESS: STREET CIN STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED):PFUN 3 CITY OF EVERETT BUSINESS LICENSE#(REQUIRE : 3 Z PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: l`2j- -7 I T&r bam ukod CONTACT EMAIL: BUILDING PERMIT APPLICATION Existing Use of Building: S e- Contract Price of Work: Proposed Use of Building: It / Heat Source: i&as ❑Electric ❑Other Building Type: `?SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial Type of Project: ❑New 1)5�ddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: / hot / d e_c_V- ASSOCIATED BUILDING PERMIT#(if applicable): �✓U/V(//�-' 3 X lb AC14 70 L/V),V& sr4C:�:; MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New Addn _Alteration _Repair Type of Project: _New Addn _Alteration _Repair #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures Fixtures A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain r Refrigeration Shower Floor Drain Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas Range Hood Other: Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: SPRINKLER/ SUPPRESSION SYSTEM Number of Heads 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 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 Building Official before=Contrors ircumstance.1 am the owner,or I am authorized by the owner of this property to perform the work for which application is made, and l comply with the SRCWand 296.200A WAC. Q / / Cityof Everett Official Use Only PERMIT#� i I(0-o�- oo� Owner/Authorized Agent Signature Date (Revised 5/20/2096) !