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OLT PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN I 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 Only Please) 4.1 PROJECT ITE INFORMATION <br /> PROJECT SITE ADDRESS: 9 25L 5 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION rV� ��//-- q (�,, y� <br /> OWNER NAME: TENANT NAME(If Commercialac V /�lca-2..lJ <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: r I , f <br /> CONTRACTOR NAME: (r)tl9NV"Q✓ /S�,ayAP P j� f ,nA r (4 f�Cfc.Q� <br /> CONTRACTOR ADDRESS: STREET 46� Q <br /> I{ E�eV8 r- 't j qH <br /> CITY UV-P,V•G-' \l STATE ky A_ ZIP T(3.9)06 <br /> CONTRACTOR PHONE: ao(7 - 7' �-—16$ 0 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE-,#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> Il,a <br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: 4h-k() $1 C.. 25 CONTACT PHONE: O - 9-3 1 -- I,6 002 <br /> ' k_ 4 --k$O EACT EMAIL: <br /> BUILDING PERMIT APPLICATION t' <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas lectric 00th <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: mmercial ❑Industrial <br /> Type of Project: ❑New ❑Addition El Remodel Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <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 /> 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 jOther:c 'd� 1/40(A.„f <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!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> r City of Everett Official Use Only <br /> PERtkli'T l �c — O(E'O <br /> O er/Au orized Agent ignature Date (Revised 9/23/2016) <br />