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0 PERMIT APPLICRION <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 + I l `^ A Vc` SC t ve/Ir-�.GWfi ?i'Loa PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> , CONTACT INFORMATION <br /> OWNER NAME: ,,La,^1 �M act TENANT NAME(If Commercial): <br /> r <br /> OWNER MAILING ADDRESS: STREET G1► 5 3C 0 <br /> CITY ��.''' STATE WA ZIP o,�3 <br /> OWNER PHONE: �+�� ng— OWNER EMAIL: 1011 3p"Yrr Woo r. e <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT,BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER ❑ �eW CONTRACTOR OTHER(Please Specify) t"�-) <br /> CONTACT NAME: CONTACT PHONE: go� __ 7 - P7 <br /> 9 <br /> n W l/-Hact., CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: (A jN 1' Contract Price of Work: $ <br /> Proposed Use of Building: f I Heat Source: ❑Gas El 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 /> VC-0 NtAri 1nSPZ (t'* cJve io oor,Q,6"f Owy f-r 61 PevbcvSly G-5 upsn/ <br /> ��)qxpa",+ 0 2-�--M -1-M111-02-1 A d v 1+ PL•",►'f?o J�' �V�� . IVB mod)����-►�frai � �'ing wf� <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 lKitchen 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 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 under any circumstance. I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and l comply with the tractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> r� C-f "7 7 PERMIT# <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />