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PERMIT APPLICATION <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 1 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: LI D H •E V (- 2 fR W O PROPERTY TAX#:0O3 00JOLqLl O 2 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:Q I n mafaL4C2 LL(:-L TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET L V CC w Cr <br /> CITY F✓v•� �� STATE w ZIP I <br /> OWNER PHONE: `` OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET 21 Q�� 1 S <br /> CITY o(�(_,{ 4 1 `Q(1,G STAT/EE ,A \\ ZIP pC. <br /> CONTRACTOR PHONE: 3 - HZL�-I3 �� CONTRACTOR EMAIL: S�4F ( �C G (Vl( ( G �l <br /> CONTRACTOR LICENSE#(REQUIRED): ER fA63FsQ� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Z 00F5q <br /> PRIMARY CONTACT: ❑ OWNER El CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> L\\DJ I LA'ks� CONTACT EMAIL: S (1 Gr1 l �( 1 f 1. O C-n <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ O d� <br /> Proposed Use of Building: Heat Source: []Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. 'Sign ❑Sprinkler ❑Demolition ❑Ch/an'ge of Use <br /> DESCRIPTION OF WORK: 1� �11��(H Q v-t n e'w wall S I 1 n and <br /> eX 15-h n y �d l e Si�i'r,• J <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 lGrease 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.1 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. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 06 <br /> Owner/Authorized Agent Signature Delta 1 (Revised 9/23/2016) <br /> 1 <br />