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PERMIT APPLICATION' <br /> "411#* BUILDING/MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 615,7477 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 ywow.everettwa.gov/permits <br /> (Blue'or Black Ink Oniy-Please) 2 PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: z.43 O m44 - S PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): a/t!.,,o 64r <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: /W ntaiL a Ce- .... 2:41....14-77v"/--C. <br /> CONTRACTOR ADDRESS: STREET 705-- , 4/6/ �'T g / <br /> CITY l/ / STATE (J 4 ZIP qC.o <br /> CONTRACTOR PHONE: ,,;20b-16i- 93 Z-S CONTRACTOR EMAIL: 6 aO €f"$ING : ,'-d 1 <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: — CONTACT PHONE: 76,b 96z 9 3Z.. <br /> Lam` CONTACT EMAIL: 6 p®xe /0,5/1./6> rJ'E-I <br /> BUILDING PERMIT APPLICATION ; <br /> LPropExisting Use of Building: Contract Price of Work:$ ZO ie--- <br /> Proposed <br /> osed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: .26-ommercial ❑Industrial <br /> Type of Project: ONew ❑Addition ,emodel ❑Repair ;aft.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> OW-7C A-A1 'e __ - Prisl- <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 /> 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 lam 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 and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 1//7 <br /> / PERMIT# -1),1--iN__ <br /> I.5 /1 7 <br /> Owner/ thorized A nt Signature Date (Revised 5/20/2096) j ) <br />