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0 PERMIT APPLICATIOID <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 4e7T 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: 2-16V5 Rcc�e-`t et l eA,- Jam- I PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: I i2 y1 Jj')eS TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 13 I -11 vL N 7j( Vc p � / <br /> CITY d m t2 III ✓�/STATE /f ZIP •�{/7� <br /> OWNER PHONE: 1 Zt� fi31 li'2 } OWNER EMAIL: J PvP' I e P ,^,»e Y>'IL 'tet C . <br /> CONTRACTOR NAME: iJ I ulo v1�' C " ',✓f"SJ7-;,,( <br /> CONTRACTOR ADDRESS: STREET 21 <br /> CITY 1.�-/-�/i(e STATE IP 1 jJ <br /> CONTRACTOR PHONE: , -1-7% 5J517y <br /> CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQ1­IRED):.5 Vu/1 D /32 ICITY OF EVERETT BUSINESS LICENSE#(REQUIRE <br /> PRIMARY CONTACT: ❑ OWNER A'-�7 CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> e'vVC, "2 U � CONTACT EMAIL: <br /> I�as�a� I ')J,,e ,ren wrl" .c� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ IfSao <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.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <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 INo. 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 qnder 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 mply with the State Confractor L w 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> T fE <br /> PERMt6 <br /> Owner/Authorized Agent Signature Date / (Revised 9/23/2016) <br />