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PERMIT APPLICATI <br /> BUILDIN MECHANICAL I PLUMBING I SIG PRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SER LL3 <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 /> (Bluff.or Alaclg Ink Only (Please) PROJEGT�SITE INFORMATION <br /> PROJECT SITE ADDRESS: 7 OI}-(G�rj• /�v V PROPERTY TAX#:bD+?M )V3C707, <br /> LEGAL for new construction: Short Plat/subdivision� I�LIG`b 5 S Lot No_Ay(a t ch copy of long legal description) <br /> q CONTACT INFORMATION <br /> OWNER NAME:G HODI7 1 f7fAOMA M-W A F-OWY TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY PW MC>N,0 STATE !7 • ZIP I v 0 3 <br /> OWNER PHONE: 4D 10 Z C."5Iv OWNER EMAIL: G V j' l �J W�1 91 &Okb <br /> CONTRACTOR NAME: O W/V <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR I&OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: pq <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: r Contract Price of Work:$ 0l'• <br /> Proposed Use of Building: !— Heat Source: %Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached SFR Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial 1:1 Industrial <br /> Type of Project: ❑New ❑Addition Ntemodel ❑Repair ❑T.l. ❑Sign []Sprinkler ❑Demolition El Change of Use <br /> DESCRIPTION OF WORK: <br /> Go N V��' fes-• GNUS�-2� � � 8�� <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 Fixfures 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 in (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 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 98.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMI # O <br /> Owner/Authorized Agent Signature Date (Revised 5/20/2096) ` <br />