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• PERMIT APPLICATION* <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 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: PROPERTY TAX#:Clej3j ^f 67 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAMEA1/ '-= F r T��L L TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET > 7 0' <br /> CITY STATE ZIP <br /> OWNER PHONE: Z _ Z C OWNER EMAIL: <br /> CONTRACTOR NAME; s //VC <br /> CONTRACTOR ADDRESS: STREET x �1, x 2-3 1A <br /> CITY 14,119 STATE ZIP <br /> CONTRACTOR PHONE: Z �� ZZ- CONTRACTOR EMAIL:S <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUI D): S <br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: /G 932 <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> ExistingUse of Building: <br /> g: /�s_ E=l'yj' L� Contract Price of Wo/5"'s <br /> $ <br /> Proposed Use of Building: Heat Source: ❑Ga Electric <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial El Industrial <br /> Type of Project: El New ❑Addition ❑Remodel Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> N C-ty K'L i p--Z t 3 rA OT14 L i-Cc-r- <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-PR<P Toilet Backflow Preventer(In ide Bldg) <br /> Forced Air Systems JXilt Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking 5Getain <br /> Water Heater Refrigeration Shower FlogrArrain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal rease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer okups Other: Clothes Washer Medical Gas <br /> Range H Water Heater Other: <br /> Exhati9f Fan Sink(Service/B op/etc.) Other: <br /> r <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I No. of Heads <br /> ACKNOWLEDGEMENT.1 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 1 c mply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 31 <br /> MIT <br /> P <br /> 3i U - oS5 <br /> wn50&i[orized t Signature D to (Revised 9/23 2016) > <br />