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PERMIT APPLICATION <br /> BUILDING/ MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> i'�'► 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION� <br /> PROJECT SITE ADDRESS: 5-7(9 " ��/ 1I NA qK2LY3 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 5t-eve 4' l3Y' Y)c L. f4(1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET f-1 (� I D n <br /> CITYej STATE Vv ZIP g12.o3 <br /> OWNER PHONE: p(,�—oX0^qqo OWNER EMAIL: L400QGJoo &con 1266i, iie�: <br /> CONTRACTOR NAME: �f <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: X OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> C � <br /> BUILDING PERMIT APPLICATION, <br /> Existing Use of Building: -_t bal /cf{ j Contract Price of W. k:$ LVOO <br /> Proposed Use of Building: Heat Source: ❑Ga ❑Electric ❑Ot <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex 0Multi-Family4 of Units: o ommercial ❑Industrial <br /> Type of Project: El New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler Xemolition ❑Change of Use <br /> DESCRIPTION OF WORK: ®/Imo/ � �(' 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 List of Fixtures #of List of Fixtures #°f 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 /> 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 com.l with the State Contractors Law 18. 7 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PE <br /> to <br /> i �7 . ''ed Agent Signature Date !� Revis 3/2016)/7 ))\ � k,`�/ <br /> ner/r h r 9 9 I ( tI <br />