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PERMIT APPLICATION <br /> BUILDING 2 CHANICAL! PLUMBING I SIGNS �INKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVIC <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I MAWeverettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS. PROPERTY T #: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: At rii4o L Z.. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2`l b-1 CXIA Val ALL , 20 t> <br /> U " crry �iU STATE 13 2nZIP <br /> OWNER PHONE: y 2 5— ` S �jy(11 Q OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> cFry STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): I CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: , 1 LC1 CONTACT PHONE: 25 .._ 32 <br /> CONTACT EMAIL: cO <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Ike— Contract Price of Work: $ v <br /> Proposed Use of Building: i' z- C Heat Source: ❑Gas electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR- ached []Duplex []Multi-Family-#of Units: b(commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. P6gn ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Sr m <br /> �t � �\ r `�� Cor <br /> +� ' <br /> ��'' CSS )co? 1 � � �L•..��� <br /> �v� Sid vCS� L �r/S��ti l ` 515'�i;X� � f X 3,n,,��C �Ck <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 /> AIC—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater lRefrigeration iShower Floor Drain <br /> Gas Fireplace lWood StoveKitchen Sink&Disposal Grease Trap <br /> Gas Range IDucting 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.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and Icomply 'fh the Stat Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 5WA VD <br /> Owner/Auth riz d Agent ignature Date (Revised 10/12/2015) 2 <br />