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0 PERMIT APPLICATION* <br /> BUILDING I MECHANICAL I PLUMBING I SIGN I SPRINKLER / DEM0LITION <br /> CITY OF EVERETT PERMIT SERVICES yam` <br /> 3200 CEDAR STREET,EVERETT,WA 98201 -{� <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I wv,Av.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE:INFORMATION <br /> PROJECT SITE ADDRESS: JT L L C'L A Y�- �(� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET (� -����1 <br /> CITY T' STATE WA 1 T zip <br /> OWNER PHONE: �j ' Q3`J OWNER EMAIL: 1`i -j�Lw/�M a S` C, 1 <br /> CONTRACTOR NAME, ._. ...��, ..._.....- .._....,..� ....M..�...... .... .... .. ... <br /> L <br /> CONTRACTOR ADDRESS: STREET P0O <br /> CITY ,Z STATE rA ZIP 9 + a <br /> CONTRACTOR PHONE: LI�.� 3 7AI 6 CONTRACTOR EMAIL: B� �-l-Q !L . <br /> CONTRACTOR LICENSE#(REQUIRED): I'JAj L--** Q QI K6 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> - �_ . - ............ .......0 __....__..... ..._ .._._ .... - <br /> PRIMARY CONTACT: El � <br /> OWNER r�^.ONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �� a3 7y�b <br /> wO 6) CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: J� 1 ) Contract Price of Work:$ C)OD <br /> Proposed Use of Building: A 0 La ^ L� Heat Source: ❑Gas lectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Du lex ulti-Family-#of Units: LI ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel KRepair ❑T.I. []Sign ❑Sprinkler ❑Derndtiom ❑Changebf�Use <br /> DESCRIPTION OF WORK: <br /> IZOATgKG WART, 1 GSD PLYW000 SOU)I-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 lGrease 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 SYS'T'EM <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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Oficial Use Only <br /> PERMIT# <br /> Yr `ZY <br /> OwnerlAut ed A9 9 Agent Signature Da (Revised 5/20/2016) <br />