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PERMIT APPLICATION— <br /> BUILDING <br /> PPLICATIONBUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 3 3 l "Re�tb�4 PROPERTY TAX#: •4/3410 7 9 te OO 900 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> /1 /1 CONTACT INFORMATION <br /> A <br /> OWNER NAME: L M 04e At)Vi-442115/N/ 6- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3(0 0 'T/1 Ail£ s, <br /> CITY e SG/7- `„ STATE IA)A ZIP 9 g A? SI <br /> OWNER PHONE:del& lig tiL/ ; 0 OWNER EMAIL: f (,.)1 'c.11 C__ /0 mew • C bcl !!! <br /> - <br /> CONTRACTOR NAME: ' L 4-M 4 f 4 /4-t. � <br /> J ,7'` & <br /> II <br /> 57AI <br /> CONTRACTOR ADDRESS: STREET (` AILI Add✓ 1 <br /> CITY .J STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED):LAI4A,( GL 0030E CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): DSS?7.3 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:E: n CONTACT PHONE: 20 U . 1../1/.1 Lica.0 0 <br /> ✓�fv,,J I r` I L 14 CONTACT EMAIL: l� LA)CI GA I a,z t nc• L c.),-c-, <br /> BUILDING PERMIT APPLICAm L N <br /> Existing Use of Building: Contract Price of Work:$ (5-0 0 <br /> Proposed Use of Building: Heat Source: ❑Gas 0 Electric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: OCommercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair DTA. ❑Sign ❑Sprinkler emolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> REMOVAL. OF A. (6/c i--edf+'-b <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 List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—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 I 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, -•. • al 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 be•re being a •.rized 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 he State Contra.o'rs -w 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 4001PEItT A__ <br /> Or iz Agent Signature Date (Revised 9/23/2016) •-'''----'-`- , <br />