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PERMIT APPLICATI N <br /> BUILD / MECHANICAL/ PLUMBING /SIG ,i ii;PRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVI 'LS <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> OL (P)425-257-8810 I 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: O�j1G, { rtJ �l}¢s`f U� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: N&01103 TENANT NAME(If Commercial): 4-w-0 <br /> OWNER MAILING ADDRESS: STREET �Q SIV A q9i- aj <br /> CITY p. STATE ZIP )-0OWNER PHONE: ��, - �0 O OWNER EMAIL: AJ Y-f: (-Y CGW--1 <br /> CONTRACTOR NAME; rS ►v>"v YLl ( A-) <br /> CONTRACTOR ADDRESS: STREET ],Z` 0 S'r �vT <br /> CITYj STATE ZIP i��2G� <br /> CONTRACTOR PHONE: 2 CONTRACTOR EMAIL: 'r-- e CO Q O l CPVL-- <br /> CONTRACTOR LICENSE#(REQUIRED): 1 �S W3 3 C-f- I CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ® <br /> PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: {Pe { kt t K;G-7 CONTACT PHONE: <br /> CONTACT EMAIL: a Q, C9 „-it <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: ( �.d7 I Heat Source: ❑Gas ❑Electric []Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Wommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair [IT.[. Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Up p&T C-�-{ H 1/E VE 1 AA / G "'A U( �l � J U-1� <br /> S(4 QT�l A�PJ I Q G� IuTJ V V l� <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 I No. of Heads <br /> 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 <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.l am the owner,or l am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> � PERMIT# <br /> 2p17 S �_7 <br /> Own /Authorized Agent Signature ate (Revised 9/23/2016) <br /> ��v <br />