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PERMIT APPLICATIC:.*: <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> ,i,31ue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: f 7APROPERTY TAX#: QQL138G3�1 (J ��� <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (,(lf}tTel;� LL—�—T-FE TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 5 p <br /> CITY �/L�fT STATE w ZIP q / <br /> OWNER PHONE: -14 2-5T OWNER EMAIL: <br /> CONTRACTOR NAME: Gf✓n n1 E<f'IAJ <br /> CONTRACTOR ADDRESS: STREET �L` l JAJ <br /> CITY L O STATE ZIP /b� <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: 1Z-V, — <br /> CONTRACTOR LICENSE#(REQUIRED): HL11l e- CITY OF EVERETT BUSINESS LICENSE#(REQUIR ):(( " <br /> PRIMARY CONTACT: ❑ OWNER KCONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: 11 �►n/ �� CONTACT PHONE: L4 ZS�') q� <br /> V(ZIY M/ Y---�`�CL�� I�r CONTACT EMAIL: RiZAeA,J <br /> BUILDING PERMIT APPLICATION <br /> :isting Use of Building: ��/�sL� f�M/L eE,S)D{NCE Contract Price of Work: $ 6 . U <br /> -oposed Use of Building: I Heat Source: V_Gas Electric E]4 e <br /> Building Type: ❑SFR-Detached SFR-Attached []Duplex ❑Multi-Family-#of Units: EIC094ercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler emolitio ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> /2uAv A)e-w <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 /> Pas 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 INo. of Heads <br /> ACKNOWLEDGEMENT.1 have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br /> ­rrent 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 /> •-°ilding 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 /> iJlld I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> P EM 11 <br /> Owner/Aul6rized Agent Signature Date (Revised 9/23/2016) <br />