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PERMIT APPLICATIO• <br /> BUILDIf MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> Orferr 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 /> (Blue or Black Ink Only Please) �{�� (PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ' 1 36 t LU (l L( Pr PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision 1 Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: n e O L7/ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 9173 rJ % / <br /> ( / <br /> CITY P/�e/ei-t STATE k/fl ZIP f� y <br /> Z D <br /> OWNER PHONE: /�/2-.5 `73 7 L/V Z Q OWNER EMAIL: he/7 I g 3, ® ���,�/, Co,� <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: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (/Z c 73 7 y q <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: S Cf/`— Contract Price of.//Work:$ / <br /> Proposed Use of Building:JC !" Heat Source: Irk as ❑Electric ❑Other <br /> Building Type: 12/SFR-Detached ❑SFF�R--Attached ❑Duplex ulti-Family-#of Units: N ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition I 'Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition C9'Change of Use <br /> DESCRIPTION OF WORK: <br /> ( ✓<'e /II.';J rii7/ s <br /> ins ri.i/ rme s; • <br /> por <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 b--Repair <br /> #of List of Fixtures #of List of Fixtures #°f 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 /> 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 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 /> PERMIT# <br /> /A / 7 <br /> Owner/Au' q&ed Agent Signature Date (Revised 5/20/2016) 1 1 <br />