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• PERMIT APPLICATION 0 <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-88.0 I FAX 425-257-8857 j(E)eve retteps@everettwa;,gov I www.everettwa.gov/permits <br /> (Blue or Black ink.Only Pleases) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ' PROPERTY TAX#: <br /> LEGAL for new construction: Short PlatisubdIvislu e —t-ot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �) TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> r,ITvSTATE i �{�V��,r�{- ZIP q ''''77 w//''}} <br /> OWNER PHONE: qZ5 377 OWNER EMAIL: <br /> CONTRACTOR NAME, H"11`1167— <br /> CONTRACTOR <br /> "1 1`1 167-- <br /> CONTRACTOR ADDRESS: STREET Mh6pad <br /> C(Tl" STATE_ /k ZIP <br /> CONTRACTOR PHONE: 5 CONTRACTOR EMAIL: rpt r C.trY1�l 'Gcfi� ( <br /> CONTRACTOR LICENSE ft(REQUIRED): CMS/1ta k1AIl j'7- d n CITY OF EVERETT BUSINESS LICENSE#(REQUiRECJ)= <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: LIZ a159 o f <br /> CONTACT EMAIL: deb 0 1 M Vkecutincj to rvi <br /> BUILDING PERMIT APPLicATi N <br /> Existing Use of Bt.lkllrn : Contract Price of $ —7 "o•0 <br /> Proposed Use of Building: Heat Source: ` s []Other <br /> B <br /> uilding pe SFR-Detached ❑SFR-Attached ❑Duplex El Multi-Famil -#of Unita: ❑Commercial ❑Industrial <br /> ❑New ❑Addition ❑Remodel ❑R4epaairr ❑T.I. ❑Sin ®Sprinkler ❑Demolition ❑ChangeofUse <br /> OF WORK: In5f" Gas p1pfr wt Y1n0 Ce - 1V1SjzW C3L rN.QC..v,— <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 /> iiigiures #of #of #of <br /> Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures <br /> ling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> ems Unit Heater Bathtub Urinal <br /> Boner 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 I SUPPRESSION SYSTEM <br /> Chemical or WaterPlo.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 be/coat Ming authorized Under any circumstance.f am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and t comply with the State Contractors Law 18.27 PCW and 296.200A WAC. <br /> City of Everett Official Use otv,i <br /> PER TIt l <br /> 10 <br /> wne/Authorized Agen ignature v Date <br /> (Revised 912312016) <br />