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PERMIT APPLICATION <br /> BUILDING/ 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 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please)+ q PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 27 ©)bt j Aui Evet°tll-762c 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: .t/l)N b TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: y� OWNER EMAIL: <br /> CONTRACTOR NAME: I'c0 c-c O� 11i1M�iR ��LvEC1 L LI� <br /> CONTRACTOR ADDRESS: STREET 15'375 ;44:)&mck.1 crt <br /> STATE W A ZIP ai 6(tc-1 <br /> CONTRACTOR PHONE: I.125 32L. 6e1(9 CONTRACTOR EMAIL: eCte..\,,e x5)--cc01 '04.j cow) <br /> CONTRACTOR LICENSE#(REQUIRED): PRO �us4o CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) t03 Gj <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) 02 (#16 OS <br /> CONTACT NAME: CONTACT PHONE: L{25 '"s'22 8c t.p <br /> ECI 1.1-1 M.p CONTACT EMAIL: Erier/e t"cV3I L(ALV5 <br /> 1 tom <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$z,©O <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project ❑New ❑Addition ®Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Adativ) LJ t-67,16-s Z wek-i-erANea ec' <br /> ASSOCIATED BUILDING PERMIT#(if applicable): e I -U Ol4,OO(6 <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 u Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler 2. 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 /> Df City of Everett Official Use Only <br /> 21�_/7 / I� PERMIT (:01-1 <br /> OIL/Authorized utrAgent Signature Date (Revised 9/23/2016) <br />