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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 /> (P)425-257-8810 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: O I g tg, PROPERTY TAX#: Q a Qz d <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (01()(LIOZ4 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Z a, r <br /> CITY S v STATE e <br /> Al ZIP <br /> OWNER PHONE: zo1 Q �• OWNER EMAIL: � �/� 6l <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY TATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EM <br /> CONTRACTOR LICENSE#(REQUIRED): Y OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ®"OWNER ❑ CONTRACTOR ❑OTHER(Ple �pecify) <br /> CONTACT NAME: DI�S��(/ ®wuf® � CO T HONE:09% <br /> J CT EMAIL: <br /> BUILDI AMIT APPLICATION <br /> Existing Use of Building: pt7 Contract Price of Work: $ X7,0 00 ! (O 0 <br /> Proposed Use of Building: Heat Source: ❑Gas BlElectric ❑Other <br /> Building Type: ❑SFR-Detached T ❑SFR-Attached ODuplex []Multi-Family-#of Units:____2_ ❑Commercial El Industrial <br /> Type of Project: El New ❑Addition ®Remodel ❑Repair ❑T.I. []Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> f,n� dna <br /> � s <br /> ASSOCIATED BUILDING PERMIT#(if applicable): / <br /> MECHANICAL PERMIT APPLICATION r' PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration Repait Type of Project: New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List ofFixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat P mp Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit/Heater Bathtub Urinal <br /> Gas Piping Bgfler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater kefrigeration 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 /SUPP SSIO <br /> N SYSTEM <br /> Number Heads <br /> ACKNOWLEDGEMENT:I have revie ed 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./am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200WAC. <br /> 1 ,r 6 City of Everett Official Use Only <br /> PERMIT# <br /> ay4L _LL,24�h I 1 (5' 1-6Gi <br /> Owner/Author' d,Agent Signature Date (Revised 5/20/2016) <br />