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PERMIT APPLICATION <br /> BUILDING/ MECHANICAL/ PLUMBING I SIGN/SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 4677- 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 l(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 8 IO 9/ -)- el S 1 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: *Msvt St TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET -fSr° �q�11 -I- py 5 E / 'n n <br /> CITY (,/ 'Ctii STATE /vim/4 ZIP 7 s•/U g <br /> OWNER PHONE: 20(o--99LF7-144OWNER EMAIL: � 5 lY k/ @ (i vrz ,CCrili <br /> CONTRACTOR NAME: 0 G 1 PLOA✓ <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: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2Co c -r L(7-Li()CO <br /> "--DaUW-v\. Sly CONTACT EMAIL: -(--S 1.'1 l\{e Ii v.e ,C cfl4i <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ti7j4... Contract Price of Work:$ <br /> Proposed Use of Building: kV 2 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 1Remodel El Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition XChange of Use <br /> DESCRIPTION OF WORK: R` ' 1 T�(//^��``h (J ` s `/ 1 .'I '(..///ry cJy Jf✓lr <br /> �oue Vw_v C.�y - YY- IV I� <br /> --Gro-w‘ - ro � . j�--{t)Ue la v 31 n .. , i-7_,,,,4-,0....p ALw <br /> ASSOCIATED BUILDING PERMIT#(if applicable): --T-6L.4- cei ✓ho t"'eit( 1'cLAn , <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 I Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler t Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration t 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`I SUPPRESSION SYSTEM tl v� <br /> r <br /> Chemical or Water ' 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 I am authorized by the owner of this properly 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 /> li a / LH2 —f 7 P 0“ -- D 13 <br /> Owner/Authorized Agen ature Date (Revised 9/23/2016) <br />