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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 4Tir 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please)e) PROJECT SITE INFORMATION% <br /> PROJECT SITE ADDRESS: 3 v 6-/vc-'e5r-ykTh L L 1.,/i) PROPERTY TAX#: O 0 e_ SsosQor` <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ,, 1/-4 e .G. icI, TENANT NAME(If Commercial): <br /> AP <br /> OWNER MAILING ADDRESS: STREET d l `�Q,� 1 t ( , <br /> e i' CITY f/(�'n�, 1 STATE �p�v ZIP Ail <br /> OWNER PHONE:4766--- rfi" /36 OWNER EMAIL: r h (,/S/Cl'✓1,�PA / g� .7 e <br /> CONTRACTOR NAME: `�---/2 5Z V ► lI/1 , <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: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACTNAME: <br /> AME: CONTACT PHONE: �2s^`Z z 7� - / 36 <br /> Dai - . 14- ave/ _-_\ CONTACT EMAIL:Th 03/Cfr - eln32 <br /> 1 4 e <br /> BUILDING PERMIT APPLICATION qq/ A.0 <br /> Existing Use of Building: Contract Price of Work:$ �(Oe()tI l/ f LI <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric @Other <br /> Building Type: @SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial @Industrial <br /> Type of Project: Ighlew DAddition DRemodel ❑Repair DT.I.L� ❑`Sign ❑Sprinkler @Demolition @Change of Use <br /> P �J <br /> ,oec k, <br /> DESCRIPTION OF WORK: Q /eiG t� i n e LA) I�-}- �� 1.-Le c L <br /> ASSOCIATED BUILDING PERMIT#(if applicable): of deck t o �` ct `� 0 <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,and local a +e 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 au,orized u .- any circumstance.I am the owner,or lam authorized by the owner of this property to perform the work for which application is made, <br /> and I comy ith the State Contra.ors Law 18.' RCW and 296.200A WAC. <br /> I City of Everett Official Use Only <br /> PERMI go., <br /> A t i .4 . i <br /> Owner/Authorized Agent Sign-ture Date (Revised 9/23/2016) <br />