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PERMIT APPLICATIC: <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN /SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OL 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: PROPERTY TAX#wgto`/0��30/G <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legaldescription) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): �/ f <br /> OWNER MAILING ADDRESS: STREET f <br /> CITY � ... STATEZIP <br /> OWNER PHONE: OWNER EMAIL: Add <br /> CONTRACTOR NAME: G �p A, <br /> CONTRACTOR ADDRESS: STREETg L <br /> CITY Z-7— STATE ZIP I <br /> CONTRACTOR PHONE: 6' j CONTRACTOR EMAIL: ,- <br /> CONTRACTOR LICENSE#(REQUIRED); X'1'1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME ` �/ CONTACT PHONE: ] <br /> �' / ! P%-i CONTACT EMAIL: LQ 11I11 C Ci ✓ C��'`lfj j <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: I Contract Price of Work:$ <br /> Proposed Use of Building: 6— Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. []Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: //V,!5 iA2l a / cTJ7VWS 4— / Plow <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 Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration 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/ 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.1 am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW d 296.200A WAC. <br /> City of Everett Oficial Use Only <br /> r <br /> '51> // PERMIT# , <br /> / / CilO-2� <br /> Owne L I e Agent g 'ture D (Revised 10/12120 5) 1` I <br />