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PERMIT APPLICATION <br /> BUILDING / MECHANICAL I PLUMBING I SIGN I 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)everettelos@everettwa,govi www.everettwa.gov1perrnits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: J&00 /,21"67- Y%W15 PROPERTY TAX#: <br /> LEGAL for new construction: Short Platisubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Z,,,;a,/ 077 SCIfLI TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS; S71REET /&w IAI 57- SC K IOtP <br /> VTY 6QEA4E-7-r- STATE LJA Z'R (D FS' <br /> OWNER PHONE: �o S- Y/9- &cJO& OWNER EMAIL: <br /> CONTRACTORNAME: 4M6P-1e,,4,) 67-AP, Z,04— <br /> CONTRACTOR ADDRESS: STREFT tJ <br /> STATE zip <br /> CONTRACTOR PHONE: `}/,r2$' 1CONTRACTOR <br /> CONTRACTOR LICENSE#(REQUIRED).AN6A1:6F-'Z7/PJt 111-,-,1 CITY OF EVERETT SUStNESS LICENSE#(REQUIRED):OS4/ </ <br /> PRIMARY CONTACT' -NOWNER 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: $425 <br /> ZA,MY '?,eA"0,J CONTACT EMAIL-15A-^,,,-- 45 AAO� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Buildin2: TContract Price of Work:$ <br /> Proposed Use of Building: lHeat Source: 0Gas 13EIectric OCither <br /> Building Type: ©SFR-Detached 138FR-Attached ®Du lex ©Multi-Family-#of Units: 13Commercial 13industrial <br /> Type of Project: ONew DAddition EIRernodel ORepair OT.I. 0Siqn ©Sprinkler ODernolition OChange of Use <br /> DESCRIPTION OF WORK: <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 Bidq) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> A Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration 1Shower Floor Drain <br /> Gas Fireplace Wood Stove Kltohen Sink&Disposal lGrease Trap <br /> Gas Ranpe Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Ran Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc,) Other: <br /> SPRINKLER f SUPPRESSION SYSTEM <br /> lChemical or Water I 77� No_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-Daviatinns must first be authorized in writing from the <br /> Building OfficW before being authorized under any circumstance.I am the owner,ori am authorized by the owner of this property to perform the work for which application is made, <br /> and f comply with the State Contractors Law 116.27 RCW and 296,200A WAC. <br /> Clty of Everett Official Use Only <br /> PERMM�AC2= <br /> Ownerlgutli(briied Agenk Signature ate (Revised 912312016) <br />