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0 0 <br /> PERMIT APPLICATION <br /> BUILDING I MECHANICAL/ PLUMBING/SIGN/SPRINKLER/ 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 I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:-- 372-0,- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 0. CJt/YljO TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET j t� Q S ✓ C' iL� 971 f <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: e)i7 5 `/ ' c� <br /> CONTRACTOR ADDRESS: STREET � '1 f/j (L7 OC9 W c�Z <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: Z4Z QD CONTRACTOR EMAIL: e S u l i Gil <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: _ D <br /> 11 j CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION I <br /> Existing Use of Building: Contract Price of Work:$ 10, 7717 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached []Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sin ❑S rinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 70 I <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 i <br /> List of Fixtures 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 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 /> IN umber 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 /> BuildingOficial before being authorized under an circumstance./am the owner,or I am authorized b the owner of this property to perform the work for which application is made, <br /> 9 Y Y P P Y P PP <br /> and I comply with the State Contractors Law 98.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only Il <br /> PERMI ' <br /> owr�er/Authorlze^gent Signature Date (Revised 90/92/2 95) j <br />