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PERMIT APPLICATION <br /> BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT.VIA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I wvrw.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS n^) V PROPf� ��ERTY TAX#: 9' 7 I �� I <br /> U/ <br /> LEGAL for new construction Short PlasuubJdivision Lot No (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME Q( N1. ,e YU� TENANT NAME(If Commercial): �;,� i� C�r +r <br /> Ytr D <br /> OWNER MAILING ADDRESS: STREET aoa ; --.L <br /> CITY . STATE 21F Yl <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE Lrvl - ZIP <br /> CONTRACTOR PHONE: 3, L-0— Id 7 I- l 3LI 5 ICONTRACTOR EMAIL: Lo r. _ _5 t 1 -. 0-0-'' <br /> CONTRACTOR LICENSE#(R EQUIREDI: ��1(9) h (S1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): �p <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT'NAME: CONTACT PHONE: D _Co--7 / <br /> L� ,o c v — CONTACT EMAIL: LQYi <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: W.lU �Q J fC'. "ZZY� Contract Price of Work:$ <br /> Proposed Use of Building � 'T A Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Otcornmercial ❑Industrial <br /> Type of Project New ❑Addition ❑Remodel ❑Re air ❑T.I. ❑Sign []Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> "���� Cc,f1r�C/ �'�Sn CSS` fCs--f CT�I�j ►�-L,��-�+ `f�C _ V <br /> ASSOCIATED BUILDING PERMIT#(if applicable). J <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 I am authorized by the owner of this property to perform the work for which application is made, <br /> and/compl with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> I D—I I) F777 <br /> t) 1'�� _ ��1 <br /> —C V <br /> Owner Auth rized Agent Signature Date (Revised 1 0/1 212 0 1 5) <br /> N1 Z- <br />