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,�>'�. PERMIT APPLICATION 0�-�C�3�� <br /> BUILDING/ NIECHANICAL/ PLUMBWG /SIGN / ���.INKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.govlpermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: � 2, PROPERTY TAX#:� QZ.� <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME�� V�� ��CH�LL TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReer\ '�j2 �VE <br /> CITY �'R 'T'T STATE Ww ZIP q$ZQ <br /> OWNER PHONE: 2�j—Q2'�— OWNER EMAIL: <br /> CONTRACTOR NAME: '(�Q � � <br /> CONTRACTOR ADDRESS: sTREEr \� �C lO3 <br /> CITY��Q� � STATE ZIP ���i <br /> CONTRACTOR PHONE: — _ CONTRACTOR EMAIL: ��'(V'p\ '1� }� ,�(}� <br /> CONTRACTOR LICENSE#(REQUIRED): � (� 1 q e I p CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): �� <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: '�(��-��6_!13 <br /> a •1 � CONTACT EMAIL: M�N�\Q���}Q(ZGN��I9T�IUUI�C(�N` <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 1 I 1 • <br /> Proposed Use of Building: Heat Source: �Gas ❑Electric ❑Other N , CSl <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: N� Fv�,N�A cE CH�G� p����KE -�2 �-�k2 <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 #�f List of Fi�ctures #of List of Fixtures #of List of Fiutures <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 /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is tn�e and correct. Work done pursuant to this permit must comply with <br /> current federal,state,and local law. The granting o(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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> — - — -- --—_—=�.. PERMIT �� � q✓ll'� <br /> � ?_ Z�l V � <br /> ' wner/ orized Agent Signature Date (Revised 9/23/2016J <br />