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0 PERMIT APPLICATION 0 <br /> BUILDING / MECHANICAL/ PLUMBING i SIGN /SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: KLA 024wyi DitAiG Vtvtk , WA �UD PROPERTY TAx#: Go L4 00 <br /> LEGAL for new construction: Short Piatlsuhdivision Lot No. %N" (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: j� TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET "LA r �Aq <br /> CITY STATE A ZIP <br /> OWNER PHONE: tji j' 2-6 Z OWNER EMAIL: <br /> CONTRACTOR NAME: fi C IG �- ± l L <br /> CONTRACTOR ADDRESS: STREET '72+1 f I <br /> CITYWN e STATE + ZIP ` <br /> CONTRACTOR PHONE: 3(p r1 2 CONTRACTOR EMAIL: AL4 l C s <br /> CONTRACTOR LICENSE#(REQUIRED): 1-6AC V- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ©OWNER CONTRACTOR ©OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 1. 71j �J <br /> CONTACT EMAIL: C I� e,, <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: lia , Contract Price c <br /> Proposed Use of Buildin : 4f le— Heat Source: ®Gas ❑Electric ©Other <br /> Building Type: FR-Detached ❑SFR-Attached []Duplex []Multi-Famil -#of Units: ❑Commercial Oindustrial <br /> Type of Pro ect: ❑New ❑Addition ❑Remodel ❑Repair ©T.I. []Sign ❑Sprinkler ODemolition ©Change of Use <br /> DESCRIPTION OF WORK: <br /> ;�-e - 9-0-0-r- tJV 5*-UOtAV�,P 0" <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 #of #of #of List of Fixtures <br /> List of Fixtures List of Fixtures 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 Bailer :Lavatory Wash Basin') Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Ran e 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 I I No.of Heads <br /> ACKNOWLEDGEMENT t 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.f am the owner,or i am authorized by the owner of this property to perform the work for which application is made, <br /> and l comply with the State Contractors LAw .27 RCW and 296.200A WAC. <br /> { ` City of Everett Official Use Only <br /> 0 <br /> 14 <br /> OwnerfAuthorized Agent Signature Date (Revised 9/23/2016) <br />