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0 PERMIT APPLICATION 4) <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OL 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: 9,14o r l PL S PROPERTY TAX#:45059-3-50006 11(2 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �I TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET v ®L C <br /> CITY STATE ZIP �'Cl <br /> OWNER PHONE: 47> —S55 ',2-L, OWNER EMAIL: <br /> CONTRACTOR NAME: e– t ^jr <br /> CONTRACTOR ADDRESS: STREET <br /> J n <br /> CITYWOO STATE Llc � ZIP <br /> CONTRACTOR PHONE: --Z 7 s n - ( CONTRACTOR EMAIL: 5f' A-K, �' QA--6 iV, A;iTE ,K EC/ <br /> CONTRACTOR LICENSE#(REQUIRED): D (JHetgK� - <br /> CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):01Gl 744 <br /> PRIMARY CONTACT: ❑ OWNER ACONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: � , � J� iv`T T- <br /> BUILDING PERMIT APPLICATION <br /> fisting Use of Building: I Contract Price of Work: $ <br /> roposed 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: i�Ir�L-nl.,4C-� <br /> Jho P, ,,v G <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 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 /> Adftrrent 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 /> ilding 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> �� City of Everett Official Use Only <br /> Owner/A orized Agent Signatur Da (Revised 9/23/2016) <br />