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PERMIT APPLICATION <br /> BUILDING .CHANICAL / PLUMBING / SIGN /S oMKLER / DEMO <br /> L,IT1C?N <br /> .......CITY DF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1_FAX 425-25T-8857 i(E)evere.teps everettw,a gov( www.evLrettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: %o-+ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivis"f - <br /> -........_ ---_ .,,_,,,_Lot No. _ (attach copy of long legal description) <br /> A�n CONTACT INFORMATION <br /> OWNER NAME: Au kt n5 O n TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STkEET 2i�N <br /> STAiG �;P <br /> 9$203 <br /> OWNER PHONE: Zc)rr, 3' +G CG,SIG OWNER EMAIL: <br /> CONTRACTOR NAME: (` + � <br /> CONTRACTOR ADDRESS: STREET (L( r <br /> STAIr t,t iA ZIP <br /> CONTRACTOR PHONE: �� r_ ( ( } CONTRACTOR EMAIL: 1 t_ <br /> CONTRACTOR LICENSE#(REQUIRED): -Zcttr'� CITY OF EVE } r elm <br /> RETT BUSINESS LICENSE#(REQUIRED): 5-6 <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL:y �"'o C,( r&I� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building EHeat <br /> ct Price of Work:.S OO <br /> Proposed Use of Building <br /> ource: XGas ❑Electric ❑Other <br /> Building Type: ASFR-Detached ❑SFR-Attached ❑Duplex []Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New Addition ❑Remodel ❑Repair OT.I. [:]Sign ❑Sprinkler ❑Demolition ❑Ghane� of Use <br /> DESCRIPTION OF WORK: <br /> .-.V] 5f la-. �S- n�,n�C ga S <br /> ASSOCIATED BUILDING PERMIT#(if a licabie <br /> p ) <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New 3( Addn Alteration _Repair Type of Project: _New _Addn _Alteration Repair <br /> #of #of #of <br /> Fixtures List of Fixtures List of Fixtures #of <br /> Fixtures Fixtures List of Fixtures List of Fixtures <br /> AIC Air Handling units Heat F�um Fixtures <br /> Pump Toilet Backflow Preventer(inside Bldg) <br /> Forced Air Systems Unit Heater Battttttb - <br /> :>Piai4 Urinal <br /> Boiler Lavato (W;g4zh Basin) Drinking <br /> Water Heater Refrigeration Shower Fountain <br /> Gas Fireplace Floor Drain <br /> Wood Stove Kitchen Sink&Disposal Crease Trap <br /> Gas Range Ductin �" <br /> Clothes Dryer Hooku s Dishwasher Roof Drains <br /> Other: Clothes Washer Medical Gas <br /> Ran e Hood Water Heater <br /> Exhaust Fan Other: <br /> Sink(Service/Bar/Mop/etc.} Cather: <br /> SPRINKLER /SUPPRESSICIN SYSTEM <br /> Number of Heads <br /> CKNOWLEDGEMENT 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 /> urrent 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 /> udding Official before being authorized under any circumstance.I am the owner, or t am authorized by the owner of this property to perform the work for which application is made. <br /> nd I comply with the State Contractors Law 18,27 PCW and 296.200A WAC. <br /> y, City of Everett Oficial Use Only <br /> PERMIT# <br /> 039 Wn r/Authorized Agsnt Signature Date <br /> (Revised 912,V2616) <br />