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pr PERMIT APPLICATION BUILDING / _CHANICAL/ PLUMBING /SIGN / SIOKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES OL 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE � INFORMATION 4e �nPROJECT SITE ADDRESS: G W PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Atyw a TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: 06 'j9 C � OWNER EMAIL: ( �—� �� ;�,,. �C�-rA eve, L u� CONTRACTOR NAME: S � vJr,�S CONTRACTOR ADDRESS: STREET 72 Fr1 /.),0 n/Cr Q CITY y STATE ZIP % L 2 / CONTRACTOR PHONE: CONTRACTOR EMAIL: IAI A- J:S 'C,N }(�,�" 10^ It.J � rrictCi-� CONTRACTOR LICENSE#(REQUIRED): t CITY OF EVERETT BUSINESS LICENSE#(REQUI ): I b^xn PRIMARY CONTACT: g OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: .26 CONTACT EMAIL: . (ut e BUILDING PERMIT APPLICATION Existing Use of Building: Contract Price of Work: Proposed Use of Building: Heat Source: ❑Gas ftElecicy ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex Multi-Family-#of Units: ❑Commercial ❑Industrial Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: �� t I �-S( �L ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn Alteration _Repair #of List of Fixtures #of List of F" ures #of List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures Fixtures A/C—Air Handling Units Heat mp Toilet Backflow Preventer(Inside Bldg) Forced Air System U Z Heater Bathtub Urinal Gas Piping ,. oiler Lavatory(Wash BasinX Drinking Fountain Water Heater Refrigeration Shower Floor Drain Gas Fireplace \ " Wood Stove Kitchen Sink&Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas Range Hood Water Heater Other: Exhaust Fan Sink(Service/Bar/Mo etc.) Other: SPRINKLER/SUPPRESSION SYSTEM Chemical or Water I INo.of Heads 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 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 Building Official before being authorized under any circumstance.I am the owner,or/am authorized by the owner of this property to perform the work for which application is made, and I comply with the State Contractors Law 98.27 RCW and 296.200A WAC. City of Everett Official Use Only PER# O� Owner/Authorized Agent Signature Date (Revised 9/23/2096) 1 Y