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• PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OL3200 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: PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: f L'ft/o TENANT NAME(If Commercial):04- <br /> OWNER MAILING ADDRESS: STREET " 60J <br /> .0 S <br /> CITY �1/ STATE ZIP <br /> OWNER PHONE: ��� ' G �7 'f�dOWNER EMAIL: <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 ❑CONTRACTOR BOTHER(Please Specify) �ys��(S S7�v, /✓S <br /> CONTACT NAME: CONTACT PHONE: Z7 <br /> CONTACT EMAIL: IjE:, 2 YA <br /> ' /1 Oa,(�yt <br /> BUILDING PERMIT APPLICATION I <br /> Existing Use of Building: h'1a Contract Price of Work:$ l rt✓7 <br /> Proposed Use of Building: OA 1174— 1 Heat Source: RGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: —ZCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ®Remo odel ❑Repair /❑T.I. ❑Sign ❑Sprinkler-j^❑Demolition ❑Change of Use <br /> DESCRIPTIONOF WORK: <br /> r'11 C v'I, L(/f�/ aQiIJA -PV <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION i PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn ZIteration _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 /> Number 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 I comply with the State Contractors L4w 18. no 296-200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT#� <br /> r <br /> &A horde Agent-Signature Date (Revised 5/20/2016) j S <br />