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PERMIT APPLICATION <br /> BUILDING / MECHANICAL I PLUMBING / SIGN ( SPRINKLER / DEMOLITION <br /> CITY oP EV RETT PERMIT SERVICE5 <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> ;Pr 425-257-3,310 i FAX 425-257-13857 ((E)avf.retfec's@ever'ettwa.gov I mvv everattwa..gov per+7l is <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 3516 eCA-. 'h �� PROPERTY TAX#: <br /> jLEGAL fog new construct on Short Plat;ar,bdivis cw <br /> got No, larar-h�=y of Inng legal desrnpLon; <br /> CONTACT INFORMATION <br /> OWNER NAME: {� ` + -j TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS <br /> W✓rq; 203 <br /> OWNER PHONE: 914PLi OWNER EMAIL: <br /> CONTRACTOR NAME: q t <br /> r <br /> CONTRACTOR ADDRESS: <br /> air " � , � <br /> `� #� STATE .� ; <br /> CONTRACTOR PHONE: ,` CONTRACTOR EMAIL: f J60,1C <br /> CONTRACTOR LICENSE At(REOUIRED): }; L Z Y 1 - <br /> 4 1 7L Y� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER 'CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: +'''�'y�t l� <br /> CONTACT EMAIL: s <br /> BUILDING PERMIT APPLICATION <br /> 1xisting Use of Buidin Contract Price of Work: <br /> proposed Use of 3uildin Heat Source as ❑Electric ❑Other <br /> 3uRding Type SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units ❑Commercial ❑Industrial <br /> ryoe of?ro)act. ❑New ❑Addition ❑Remodel Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> )ESCRIPTION OF WORK: <br /> CpLnce &—�- <br /> kSSOCIATED BUILDING PERMIT# 'if applicabley <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> ype of Project: New Addn —Alteration _Repair Type of Project: New Addn Alteration <br /> #of — i — — — —Repair <br /> Rxtures List of Fixtures #of #of List of Fixtures #of <br /> Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> I 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 Ductin Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> E� <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Sarvicelt3arlMop/etc. Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads <br /> ;KNOWLEDGEMENT.-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 /> rrrent federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom. Deviations must first be authorzed in writing from the <br /> iildirg Official before being authorized under any circumstance.I air,the owner or 1 am authorized by the owner of this property tc perform the work for which appiicalicn is made, <br /> id t comply with,the State Contractors Law 18.27 FCW and-36 246A WAC. <br /> Cit j of Everett Official Use Onfy <br /> �,.�.,,r�+� <br /> ivrterfAuthoriZed Agent Signature Dam- — <br /> (Revised 9, <br />