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0 PERMIT APPLICATION* <br /> BUILDING / MECHANICAL/PLUMBING / SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 1(E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE /TRESS'/ PROPERTY TAX#: a0 j_ / Z 2-' - 0 2 _ ot) <br /> LEGAL for new construction: SI-9-plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: D-e 6b ,,S ;e — L,I t E, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2 17 ro Hyl <<v S j£, 14 <br /> CITY ,� e STATE ZIP <br /> OWNER PHONE: - 3 (Q - c Lo C)S OWNER EMAIL: tt e 5 <br /> CONTRACTOR NAME: 0 W Mf-(— Cr lit)t i P✓ <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: °{ Z5 -'7S-O - 0101 !'- CONTRACTOR EMAIL: i.vt Ste'-ro QT <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER OCONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: -7 5o 0 1 <br /> �--- <br /> CONTACTEMAIL: WISN_r'C Ore Ga-g*Lti5 , pie <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: rjF Contract Price of Work: $ 200 0 <br /> Proposed Use of Building: F /4 Heat Source: KGas ❑Electric ❑Other <br /> Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ZRemodel ❑Repair [IT.]. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: n <br /> i,(- el a),LN 'to <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 /> 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 Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> Zo , <br /> �l , /A � L//? 7 PERMIT# <br /> Owner/Authorize Agent Signature -f' Date (Revised 10/12/2015) <br /> � v <br />