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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/ 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 R(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SiTE ADDRESS: L �-q'I'1- a-' ,?-O( PROPERTY TAX#:QOS 15 01 S <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: STREET3/y �D ,)-4+— <br /> s <br /> r CITE 4 STATE WA ZIP r <br /> OWNER PHONE: (07{pS OWNER EMAIL: <br /> CONTRACTOR NAME: TCir U ctaKg ttIC, <br /> CONTRACTOR ADDRESS: STREET ,r�,(4a� 131 <br /> j1 S" A E <br /> CIT' a )i1 I it STATE ZIP 07 0 <br /> CONTRACTOR PHONE: 300 (05q q(p 4 CONTRACTOR EMAIL: AIYC�U ors G�- <br /> CONTRACTOR LICENSE#(REQUIRED): AT k Q(AD 3 9„N CITY OF EVERETT BUSINESS LICENSE#(REQUIRE : ®N9 I go <br /> PRIMARY CONTACT: ❑OWNER A CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: �A �? CONTACT PHONE: 300 (PS <br /> iJi ,ridtZ tic+�IY1Y13S CONTACT EMAIL: (spa@(C1lt C�-�F�. <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ��} � t t �L&r)eii, Contract Price of Work: I 0Q <br /> Proposed Use of Building: i�'1� Heat Source: 91GaS Electric Other <br /> Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑ ommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel []Repair ❑T.1. ❑Sign ❑Sprinkler ❑ on ❑Change of Use <br /> DESCRIPTION OF WORK: r na W IQ t 4hd 0-dc ;ej ka-O°F'pa m p <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New — Addn 7AIteration _Repair Type of Project: _New _Adds Alteration _Repair <br /> #of #of #of <br /> Fixtures Fixtures <br /> Fixtures List of Fixtures List of Fixtures #of List of Fixtures List of Fixtures <br /> Fixtures <br /> AIC-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 /> =Exhaust <br /> Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Ducting Dishwasher Roof Drains <br /> ookups Other: Clothes Washer Medical Gas <br /> Water Heater Other: <br /> Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I- I ]A <br /> 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 /> 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 t 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 /> nCity of Everett Official Use Only <br /> rte_ =312016) <br /> r 1 � C)r l <br /> Owner/Authorized Agent Signature Date <br />