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0 PERMIT APPLICATION* <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 4C77- 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I wvvw.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFOR <br /> �MATION <br /> ROJECT SITE ADDRESS: ?j rj" ti PROPERTY TAX#: <br /> LEGAL for new construction: Short Plattsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> WNER NAME: {2{/y► (� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME; J L� AQ � iJ�L <br /> CONTRACTOR ADDRESS: STREET �•T 07 00'x6, <br /> CITY Al STATE U4. ZIP <br /> CONTRACTOR PHONE: LIt5 14 01, CONTRACTOR EMAIL: (t6 )X*. f-C44^ <br /> CONTRACTOR LICENSE#(REQUIRED): ��: 1l9)l7 1I�1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED ®) <br /> PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (14-11, v b 4 an. `7 <br /> CONTACT EMAIL: erD Q. :Ff2d1T1i FA. CZ:P <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ 771 Op <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 /> 15-rc)&F <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 INC. 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 L w 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 7I '�� I� PERMIT#6 <br /> Owner/Authorized Went Sign re Date (Revised 9/23/2016) U <br />