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110 <br /> PERMIT APPLICATION. <br /> I UILDING / MECHANICAL/ PLUMBING /SIGN / SPRINKLER/ DEMOLITION <br /> 104 CITY OF EVERETT PERMIT SERVICES <br /> 47 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (;_-lame or slack Ink Only Please) PR*J[ECT SITE Ir FOi-MATION <br /> �.�{ i, <br /> 'Y PROJECT SITE ADDRESS: 6/S /`//G1t NG 4AO )K' PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No (attach copy of long legal description) <br /> _ &11TACT IN <br /> C FORMATION _ f <br /> J$-' OWNER NAME: 0 -ki S ro.je TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 44/55 /74,i/Low) Vi <br /> i <br /> city EVLA'E7A1— SIA 1,`-''71 ZIP 7e,2o3 <br /> OWNER PHONE: Lj 3Q "l/�� �sai OWNER EMAIL: <br /> CONTRACTOR NAME: OVV V Wr <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STA IL I: <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 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 0 Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ir <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 E Repair <br /> #of #of List of Fixtures List of Fixtures #of List of Fixtures #°{ 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 /> -- <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.) i-- Other: 1 IAN 1,0t461,-,0 las,,,.41401 of <br /> . <br /> SPRINKLER/SUPPRESSION SYSTEM mayv 4DJ/t j <br /> Chemical or Water ��-�_E J . 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 /> C2,.>"/___,A,„\.... ,30.7......AL,..,_4___(aK,..,7" PERMIT# <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />