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�"� -to3c� <br /> PERMIT APPLICATION <br /> BUILDING , ����CHANICAL/ PLUMBING /SIGN / Si�Tt1NKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:�3� K �{ , v�I� �ao�1 PROPERTY TAX#:(�Oy�� Q I(p(� <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDR S: sTReer� <br /> CITY�� h� � STATE N ZIP � � ' <br /> OWNER PHONE:Q�I',3��-�p � OWNER EMAIL: <br /> CONTRACTOR NAME �P{�, ' � C <br /> CONTRACTOR ADDRESS: s-rREFT Q3 <br /> CITY l� STATE ZIP � Z g <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: , C <br /> CONTRACTOR LICENSE#(REQUIRED): IAQQQH�� �X p g CITY OF EVERETT BUSINESS LICENSE#(REQUIRE : D5�-y�O <br /> PRIMARY CONTACT: ❑ OWNER ONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME:��a� �,�e� CONTACT PHONE:'�(�-��.-(��( ?� <br /> ��.�rjr� ���n CONTACT EMAIL:�yeY�d�tJ� � ,�(J'� ,C <br /> BUILDING PERMIT APPLICATION <br /> � � <br /> Existing Use of Building: Contract Price of Work: $ .� <br /> Proposed Use of Building: � �(�,Q/� ��Q Heat Source: �as ❑Electric ❑Other a, <br /> Building Type: ❑SFR-Detached FR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 1�5�11 n LI`C!L --Q Ui (�`�� <br /> �� �.0 ur r�e� , <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 _Repair <br /> #of List of Fixtures #of Lisf of Fixtures #of List of Fi�rtures #of List of Fixtures <br /> Fixtures Fixfures Fi�ctures Fixfures <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 /> 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 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� a��� I� ��V D� <br /> erlAuthorized Agent Signature Date (Revised 9/23/2016) <br />