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PERMIT APPLICATION <br /> OATBUILDING /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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: s ( o d 4r S� ��/t4.70, c'dz,) 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): 5'( � � ffp/tArd <br /> OWNER MAILING ADDRESS: STREET d <br /> CITY STATE ZIP <br /> OWNER PHONE: ` ( OWNER EMAIL: <br /> CONTRACTOR NAME: C LAI"c t 1/1/10-- <br /> CONTRACTOR <br /> /1/1S--.CONTRACTOR ADDRESS: STREET <br /> CITY G STATE ZIP <br /> CONTRACTOR PHONE: I 7,c-'33O -41 1 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): A C C (Z. 1) R (' 0,(1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): OS 3 y 3 <br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (IOSf'OS- -q- \Z 3�r <br /> 9,a V\.-Q,' '3001 CONTACT EMAIL: d ({h P/I 0 �� 4 _f f i b 1,1 S. ( t0 <br /> BUILDING PERMIT APPLICATION FJn U <br /> Existing Use of Building: Contract Price of Work:$ 0 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family #of Units: ❑Commercial 0 Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> CtS lit -- kA4t/'r` )'ti U 01 V,w'\-1 rl <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 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 /> PERMIT# <br /> t a fAct 17 Art S1 `.7 D9-00$ <br /> 0 oriz-- •gent Signature Date (Revised 9/23/2016) <br />