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PERMIT APPLICATION <br /> ,elfrz**/"-_ BUILDING I 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 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue'or Black Ink Orly,Please) ' . ,PROJECT SITE INFORMATION u , <br /> PROJECT SITE ADDRESS: 7 Z..„S /..._/.91-(4/^e / i✓' PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT.INFORMATION . <br /> OWNER NAME: 4-!t3 Ai ttla Ili`—� _ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS:�pSTREET PO [�i7be- I a&O2- 1-7 <br /> E,C,f`4,0 e''v CITY STATE btr141--- ZIP 9 ( zo 6 <br /> OWNER PHONE: )2‘---- ((22 2-Z OWNER EMAIL: <br /> CONTRACTOR NAME: 6 U.-T 4-02--- <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#( QUIRED) CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) <br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> ' BUILDING PERMITAPPLICATION .; _ <br /> Existing Use of Building: r i .eeG/tom. Contract Price of Work:$ e .es.t. <br /> Proposed Use of fBding: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel El Repair ❑T.I. ❑Sign El Sprinkler ❑Demolition El Change of Use <br /> DESCRIPTION OF WORK: ' .-Lej / c'h ��,lF S itc ` 700( q J T G-(-- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION. PLUMBING.PERMIT APPLICATION <br /> Type of Project: .ew — 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 /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> / <br /> / Forced Air Systems Unit Heater Bathtub Urinal <br /> 4-1 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 j Ducting Dishwasher Roof Drains <br /> j Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> L Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number 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-,. 96.200A WAC. <br /> City of EverettOfficial Use Only <br /> 01A_, /''-� PE cap <br /> Owner/Authorized Agent Signature Date (Revised 5/210/2016 <br />