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0 PERMIT APPLICATION 10 <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OL 3200 CEDAR STREET, EVERETT,WA 98201 <br /> Am (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> lue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 7/ /nE('-v/1'1 PROPERTY TAX#:6b75 0CZ00 ak2 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 22Q CA TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET f�2 <br /> CITY CVE2ET STATE w ZIP <br /> OWNER PHONE: 257-530-6 1?3 OWNER EMAIL: <br /> CONTRACTOR NAME: LUM IrtJ /� <br /> CONTRACTOR ADDRESS: STREET / 3 I/v <br /> 'J CITY STATE � ZIPq&-O <br /> 1 <br /> CONTRACTOR PHONE: 1a ;/- CONTRACTOR EMAIL: �j u�� Al/l/'�,A/� <br /> CONTRACTOR LICENSE#(REQUIRED): 'Dt?-yj.J_r7P1+qL1L1 fQ ICITY OF EVERETT BUSINESS LICENSE#(REQUIRED):0/&17ql <br /> PRIMARY CONTACT: ❑ OWNER XCONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Z!;— 5 6 <br /> CONTACT EMAIL: <br /> Kl" CLl <br /> BUILDING PERMIT APPLICATION <br /> -xisting Use of Building: Contract Price of Work: $ <br /> roposed Use of Building: Heat Source: Gas ❑Ele'ctric ❑Other <br /> Building Type: ❑SFR-Detached SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Spri�nikller ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: IQEPL4Ce t;X): 77VA1 6�L i�U� /�'l2 W <br /> A)FW &itsJCW S,gA16 I,OCAT►4A�J tler& 6� <br /> r►zd,,-,, rn-���2 �rr�-�✓�4 eE L OC�r-7�v�.1 <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 /> Chemical or Water I I No. 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 /> jlftrrent 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 /> IWJlding 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 /> PERMIT# <br /> Owner/Au orized Agent Signature Dae (Revised 9/2 /2016) <br />