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0 PERMIT APPLICATION 0 <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 4L 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: y �h G S F 5ft, 0$ PROPERTY TAX#:Q O <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAMESII �rl . TENANT NAME(If Commercial): twf'I(A lInsuco fl- <br /> OWNER MAILING ADDRESS: STREET _ -S+-C 1069 <br /> CITY 0.e\jSTATE ZIP OD5 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: � j - <br /> CONTRACTOR ADDRESS: STREET 5. <br /> CITY MOIJMUff n STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: +` M <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):2FO f <br /> PRIMARY CONTACT: ❑ OWNER .CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT <br /> NAME: I l CONTACT PHONE: (�D- U ZL(— �S <br /> V\ d ���S-` CONTACT EMAIL: S Cyd I Cam <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <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.l. IRSign []Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> \n5�-Qtl'tA9 one n_w tjl(Amina� UJa I,( <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 /> IN umber of Heads <br /> ACKNOWLEDGEMENT:1 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.1 am the owner,or 1 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 /> PERMIT# <br /> cf� �d 7 I� 5160,10 '00 <br /> OwnerlAuthorized Ageptf Signature Dat (Revised 9/23/2016) <br /> ()DA <br />