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PERMIT APPLICATION <br /> BUILDING / MECHANICAL I PLUMBING I SIGN / SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EY 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECTSITEINFORMATION <br /> PROJECT SITE ADDRESS: 132 Y Ayp PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): ESYtt7C <br /> OWNER MAILING ADDRESS: STREET IJ .�40 -15--' AYE QnT <br /> CITY STATE WA zip <br /> r <br /> OWNER PHONE: (<4'4h Ve I• 2000 OWNER EMAIL: darmn.regi tGK"s vroYcderlce.c�" <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET tt� Q <br /> /� CITY OV4 " STATE WA zip <br /> CONTRACTOR PHONE: -64- CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR 390THER(Please Specify) A't?l.,H CS�C1-T' <br /> CONTACT NAME: CONTACT PHONE: �sf2Gj� �J� L1�3�P8 <br /> ��Ytt-1 SAYL�J�- CONTACT EMAIL: Ytr7C��t7E?�'1•�It"1 <br /> BUILDING'PERMIT APPLICATION <br /> Existing Use of Building: •'2- Contract Price of Work:$ (�0��44• DD <br /> Proposed Use of Building: 4{0o3IpNAL t'2 Heat Source: ❑Gas ElElectric []Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex E]Multi-Family-#of Units: oCommercial ❑Industrial <br /> Type of Project: ❑New @Addition Remodel ❑Repair EIT.1. ❑Sign E]Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 1 �2(Q•� d� L en= 1C?tt-'T-," 44, WAK-may <br /> AV-6 A -rZ> AT(D l�1 Gdd�/V�l�hL 1GA?�"IO t� <br /> s'tA`r'1�1. <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 <br /> #of <br /> List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures List of Fixtures <br /> 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. City of Everett Official Use Only <br /> PERMIT# <br /> • 05. 2g <br /> Owner/Authorized ent Signature Date (Revised 10/12/2015) <br /> ..j <br />