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0 PERMIT APPLICATICO <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 4,E7T 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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: WjOA IN UAWQ - rZ 1 ba I PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER IVAME: Q�w� } u,(1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET p J <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: f L n e <br /> CONTRACTOR ADDRESS: STREET 06 x W6U <br /> CITY \ `CJ O�_ STATE INA ZIP q o:�-a <br /> CONTRACTOR PHONE: {{ CONTRACTOR EMAIL: Qt e anmec��n (LOIS .014 <br /> CONTRACTOR LICENSE#(REQUIRED): WE6 ML C Q` CITY OF EVERETT BUSINESS LICENSE#(REQUIR <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT <br /> pNAME: <br /> i1 CONTACT PHONE: <br /> C lt1 v tY\ CONTACT EMAIL: �t`f MRV-�(Un (YlWqo niw(of . <br /> BUILDING PERMIT APPLICATION ---- <br /> Existing Use of Building: Contract Price of Wor $ Coo <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 1�k.I. ❑Sign ❑Sprinkler ❑Demolition ❑ hange of Use <br /> DESCRIPTION OF WORK: 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 XAddn _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 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 /> 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. 1 am the owner. or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I com ly with the State Contractors Law 18 4 27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> T'( �' oC) � <br /> Owner/Authorized Age nature Date (Revised 9/23/2016) <br />