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OLTPERMIT APPLICATI <br /> BUILD010/MECHANICAL/PLUMBING /SIG RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 13 j' UTp-1 gelZ a t PROPERTY TAX#: <br /> / <br /> LEGAL for new construction: Short Plat/subdivision 1 A Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATIONen • 3 q <br /> OWNER NAME: 'r- ( 'IL, J c, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 6 o rror r ? 1ur 4 J‘ik• r6 `^c 1 �6 V)6 l b 6"7 ,7 <br /> CITY f`V-�e-"�j-'" STATE SNA ZIP '°/0 tC-,6 <br /> OWNER PHONE: 3,6.t ‘ o 6 93 3 °( OWNER EMAIL: <br /> CONTRACTOR NAME: C <br /> CONTRACTOR ADDRESS: STREET 3--e----414-(I(S fu ut)jS r �{ <br /> � <br /> cm, STATE W A f ZIP '/ 1 y <br /> CONTRACTOR PHONE: 7..."6 Lf C—� O L� 1( CONTRACTOR EMAIL: I C a Li„ IPA C,.J,�.O J n s <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUI ):QL{2 S6 <br /> PRIMARY CONTACT: 0 OWNER MCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: '_O G ((S S` Oki <br /> AA h X CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION l <br /> Existing Use of Building: Contract Price of Worirl , O( ) <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: CI New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ( 1 <br /> Coq eN(�.( c_� f/` C n Len.` UI v G <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_ Addn _Alteration 0(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 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 I 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 /> 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 1 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 296.2004 WAC. <br /> City of Everett Official Use Only <br /> '77/3 /2-oinPERV V--C)2 — OO, <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />