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PERMIT APPLICATION <br /> BUILDINGTNIECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 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 /> PROJECT SITE INFORMATION <br /> PROJECT IT ADDRESS: PROPERTY TAX#: <br /> / E, 101111 a V If V1 e <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: D61,10(d 0VK0-S. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET `�(7��' " - ( I- <br /> < <br /> - <br /> CITY Jrc�O-Ty STATES ZIP <br /> OWNER PHONE: 'L✓C� '" �laU`� OWNER EMAIL: GQa•:`fcQ_T vtGer cts F? Q kjr--etwqC•r. cr <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: $�OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: cyrn e- Cr--s 0C'- :')tom; <br /> CONTACT EMAIL: <br /> BUILDINGPERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: <br /> Proposed Use of Building: SF(2— Heat Source: ❑Gas XjElectric ❑Other <br /> Building Type: ❑SFR-Detached ZSFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition AKRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: �vt (c� Cie vl"a. �� C'-'06Z<� - D'2'-'0C fi�C t��cX� c v�S Ut({ <br /> hCA" cc--f- CXC y-'.SS �ocv�,•, ��cur=1 � Cc�tn.s'� vt=ck �� cz�v� -E rC� c., c�P �fzr_t�� t���ocr <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn VAlteration _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 Z Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration % Shower — Floor Drain <br /> — Gas Fireplace Wood Stove t Kitchen Sink&Disposal — Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Z Clothes Dryer Hookups — Other: / Clothes Washer Medical Gas <br /> % Range Hood <br /> \. W ter-Heal--�- 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 /> r <br /> RMIT# I <br /> ` ri_ <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br /> �i <br />