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PERMIT APPLICATIONI• <br /> ,, BUILDING/MECHANICAL/ PLUMBING /SIGN/SPRINKLER/ DEMOLITION <br /> 11111P410,-- CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Plea(se)( � PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: LLP\ l V V l�uc PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: K., n u‘ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 'Z6(/ i'- A teZz 5 7- <br /> e-e-(/' <br /> (/((G C r STATE GQ ZIP I co?„G/ <br /> OWNER PHONE: L-(Z5- 4141/ 3? 3 c2 OWNER EMAIL: <br /> CONTRACTOR NAME: K4->/0 r i j9 c <br /> CONTRACTOR ADDRESS: STREET Z 7 3 Z 6 ( G(1 -i C-1/7 / L�/� ^� <br /> CITY (/T(--G__I I STATE 1 V 9 ZIP G/ <br /> CONTRACTOR PHONE: e Z 5'679- -531-� 1( CONTRACTOR EMAIL: 110�� ! <br /> CONTRACTOR LICENSE#(REQUIRED): 'tet �� '/y71112 c/Z RZ.G(/k CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):5-41 Z7 <br /> PRIMARY CONTACT: 0 OWNER "ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (�l 7s- 7 T 1-5-3`7 <br /> NT <br /> " J(AC r/v1 CONTACT EMAIL: 1J/oN Jr�_ �) 14--XId /l w, �G <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 3 /-,)r- -- <br /> 2 <br /> Proposed Use of Building: 77-c Heat Source: DGas Ictric DOther <br /> Building Type:/21SFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: DNew P,tidition DRemodel DRepair DTI. ❑Sign DSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: f (G/ G/ G <br /> fri <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 /> ( 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 properly to perform the work for which application is made, <br /> and I comply with th- ate Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> - PERM sue, <br /> o` a <br /> Owner/Authorized Agen ignature Date (Revised 9/23/2016) <br />