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PERMIT APPLICAN <br /> BUILDING / MECHANICAL / PLUMBING 1 SIGN f SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 k FAX 425-257-8887 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Biack Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: A35- PROPERTY TAX#: <br /> LEGAL for new construction: Short Platisubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: i>4vt TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET 4435' S"sA u <br /> CITY 6'V1F4t6'tr STATE k6z,P F <br /> OWNER PHONE: 40(.— f 411'r 1 fr7 { OWNER EMAIL. •t 6A*1a..4,0 <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET t <br /> clTv STATE ZiP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#aREQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: OWNER O CONTRACTOR O OTHER(Please Specify) <br /> CONTACT NAME: ___,. CONTACT PHONE: "7 <br /> rY : fi r 6 c e r2 CONTACT EMAIL: i c"e A <net d -J 3?G7 r-1 C-7#V"6le <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: <br /> Proposed Use of Building: Heat Source: OGas OEleo <br /> Building Type: ©SFR-Detached ClSFR-Attached []Duplex__ OMulti-Family✓#of Units: OCornmercial Olndustrial <br /> Type of Project: ❑New OAddition ORemodel EIRepair OT.I. ©Sion OS rinkler ODemolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: <br /> Vz� 4,S <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 <br /> List of Fixtures List of Fixtures Lief of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> APC-Air Handlin Units Teat 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 1wood Stove Kitchen Sink&€disposal Grease Trap <br /> Gas Rancle Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink `Service/BarlMo fetc.) Other: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Chemical or Water JNo.of Heads <br /> ACKNOWLEDGEMENT-l have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must CampBy with <br /> current federal.state,and local taw. The granting of a peraki only authodzes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Suilcing Official before being authoriz�t nder any circumstance.i am the owner,or I am authorized by the owner of this property to perform the work for which application is Mac <br /> and i comply with the State Contactors Law 18.27 RCW and 296.200A WAC. <br /> / City of Everett Official Use Only <br /> PERMIT# <br /> (�12.011 - V <br /> t7wAuthorized Agent Si nature Date (Revised 912312016) <br />