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0 PERMIT APPLICATIA <br /> BUILDING / MECHANICAL/ PLUMBING/SIGN/SPRINKLER/ DEMOLITION <br /> 07 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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: O �13 •�L��y f w��. PROPERTY TAX#: /CC -75331tC)5 <br /> LEGAL for new construction: Short Plat/subdivision ____Lot No._____ (attach copy of long legal description) <br /> CONTACT INFORMATION ( // <br /> OWNER NAME: CQ« C �TENANT NAME(If Commercial): Z( j-Lc <br /> OWNER MAILING ADDRESS: STREET 1502 VRUCJ:-'r-2r � /Y <br /> cry t5kjqi�lE {� STATE �.N ZIP ��f <br /> OWNER PHONE: - OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY S TAIL= 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: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: []Gas ❑Electric ❑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 ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 0A49c,vlV �- i�4S f v-1 r- <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 _1 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 pToilet 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 IS.hower 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 confinn the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federal,state,and locall w he 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 ein a ori ed under any circumstance.1 am the ow r,or authorized by the owner of this property to perform the work for which application is made, <br /> and I cromply with Sat tra ors Law 98.27 RCW and 296 200A WA . <br /> City of Everett Official Use Only <br /> PF_RMIT# <br /> '!� - - I ;'' l _ 1oy -' � 2-S <br /> Owner/Au riz Agent Signature Ddle (Revised 5120/2016) <br />