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PERMIT APPLICATION <br /> BUILDING ; MECHANICAL/ PLUMBING /SIGN / ZF RINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OL <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 /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ti ROPERTY TAX#: <br /> L x �« <br /> LEGAL for new construction: Short Plat/subdivision 15'-(,7C 7 Lot No.a (attach copy of long legal description) <br /> t CONTACT INFORMATION <br /> OWNER NAME: R.,C�-- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: (�L `i a �� Ht`vaes <br /> CONTRACTOR ADDRESS: STREET <br /> CITY ✓.�� Sv STATE U-11 'ZC) <br /> CONTRACTOR PHONE: �Z�'Zqlj a CONTRACTOR EMAIL: Cid Ir1C�(LCkI�z27tffi�'1r.S , C t'✓�I <br /> CONTRACTOR LICENSE#(REQUIRED)4aLl.o—:�-o i CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):0,5_3 Q(�, 7 <br /> PRIMARY CONTACT: ❑OWNER D CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: �\ CONTACT PHONE: L, — 2— <br /> CONTACT <br /> CONTACT EMAIL: _3 ,--e VyC\CLC k <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 75 f <br /> Proposed Use of Building. S 1— Heat Source: ®Gas []Electric ❑Other <br /> Building Type: 55SFR-Detached FR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ORNew ❑Addition ❑Remodel []Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 'Q &'-� S ! v A <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 /> Gas Piping Boiler ey Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove / Kitchen Sink&Disposal I 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 /> Number 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_Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.t am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and/comply with the State Contractors aw 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> I IC 140!),5 1-3 <br /> Ow erlAu Agent Sig u Date (Revised 10/12/2015) <br /> L <br /> _J: <br />