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PERMIT APPLICATION <br /> JO <br /> / PLUMBING / SIGN / r'RINKLER/ 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 J www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: , \%(t 'aL,O$k=Lir C-ec a-&-rr 11 WT PROPERTY TAX#: Lo Li y c tZ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: yAL C,lu-e-,kl S TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET . (�Dl �Lr ��, 7 <br /> CITY = - _� _` STATE t ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: I-)(- <br /> CONTRACTOR <br /> i S S _ ,J`CONTRACTOR ADDRESS: STREET �(Lc„J Vw I urTCJ <br /> CITY �7 L��(C- STATE 1- ZIP RrAy <br /> CONTRACTOR PHONE: 2S 3— 1 Z- CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): �--t =Ste\ q&STZL--) CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTA :CT PHONE: -L 3 cl ' ` _to 0 J <br /> �� CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 2.L i Contract Price of Work: $ d S' <br /> Proposed Use of Building: (LC Tv.,I L-- 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 WT.1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 1tiST�L--- '1_ AtC-v l- \�Lo- 1-21 VIC<'S. <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 _Adds _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 aut ri ed 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:complwithy the State Co ra ors Law 18.27 RCW and 296.200A WAC, <br /> City of Everett Official Use Only <br /> PER I <br /> } G <br /> Owner/Authorized Agent Signature Date (Revised 5/20/2016) <br /> �J <br />