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PERMIT APPLICATION <br /> BUILDING /MECHANICA / PLUMBING / SIGN t SPRINKLEF �1 <br /> OF EVERETT PERMIT SERVICES4e7T ` fr <br /> 3200 CEDAR STREET,EVERETT,WA 98201 T <br /> (P)425-257-8810 i FAX 425-257-8857 i(E)everetteps@everettwa.gov( www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) ��y PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: i til S�Y1 Q PROPERTY TAX#: )0 <br /> LEGAL for new construction: Short Piatlsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: I S M"aA/\ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET `i W. MR t6 b t� , <br /> t CITY �Y l STATE 1 ZIP <br /> ``f <br /> OWNER PHONE: 95 OWNER EMAIL. <br /> CONTRACTOR NAME: Ag�- D t <br /> CONTRACTOR ADDRESS: STREET P el <br /> CIN STATE IiIr YA ZIP <br /> CONTRACTOR PHONE: 3100 �asq 47L4 CONTRACTOR EMAIL: Of-A 0-10, i-trav&&-s <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 300 (551 R(o q `1 <br /> c i ri n ig CONTACT EMAIL: 0 Q t f <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ ��U <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. ❑Sign []Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> new 3P T r✓�� , <br /> 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 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 /> Chemical or Water I No.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.i am the owner,or i am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> o �� r`? 1' 70 9-60 <br /> Owner/Authorized Agent Sigiftature Date (Revised 9123120 f6) <br /> ......_........._._........ __ <br />